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If preventive medicine continues thus to advance in keeping off disease, may we not yet verify M. Flourens' estimate of one hundred years as the natural duration of human life?

Before proceeding with the work of the Convention I would be doing injustice to my feelings were I not to render to the Faculty my cordial thanks for the honor they have conferred upon me by selecting me as their president.

May I not claim, gentlemen, another favor at your hands-your kind indulgence for my inexperience in presiding over deliberative bodies?

ANNUAL ADDRESS.

RECIPROCAL ACTION OF MORBID BODILY AND MENTAL INFLUENCES.

BY A. M. FAUNTLEROY, M. D.

Mr. President and Gentlemen:

When the highly flattering invitation to address your Society was received, the first thought that flashed across my mind was that your Executive Committee were surely ignorant of the fact that the long vexed question of a boundary line between Maryland and Virginia had been, within a recent period, settled forever. However, when sober second thought assumed its sway, there arose the pleasing reflection that while Maryland could proudly boast of many distinguished sons by whom the task assigned to me would have been far more acceptably performed, yet the Potomac had been crossed in order to herald the fact that medical science and the profession of medicine recognized neither State lines nor geographical boundaries--that "in a cause so excellent as ours, there exists neither creed nor nationality, but we are all one." When I recall the honored names of those who have preceded me in this appointment, and recognize among my auditors many stalwarts of the profession, I need hardly say that my sense of the honor conferred is measurably deepened, while my full appreciation of the responsibility assumed is in nowise calculated to lessen my present embarrassment. When I accepted the invitation, so cordially extended, my classification was strictly among those whom the public derisively style "mad doctors." Since that period, however, I have received my discharge-although it may appear from the subject-matter of my utterances that mine is scarcely a case of even partial recovery.

I feel fully assured, however, that the profession of Maryland, in recognition of the unity of medicine in its various departments, will grant me a patient hearing while I essay to make some plain and

practical observations upon the reciprocal action of morbid bodily and mental influences.

The correlative action of body and mind is the foundation upon which medical psychology reposes, and constitutes a consideration which general medicine cannot fail to recognize as one of great importance in the observation and treatment of so-called bodily disorders. Without entering into the merits of the discussion between spiritualists and somatists, as to whether the mind is a mysterious entity, different from and vastly superior to the body which it inhabits. and uses as its earthly tenement, or is merely the functional outcome of the molecular activities and physiological mutations occurring in the cerebral structures, I shall assume the existence of a mental force in the human organism, associated with, yet the superior of the vito-physical energies therein manifested. Regarding the associated yet distinct existence of such a force, I may in this connection pertinently appropriate the remarkable utterance of the great English physicist, wherein he declares that "the passage from the physics of the brain to the corresponding facts of consciousness is unthinkable." Granted that a definite thought and a definite molecular action in the brain occur simultaneously, we do not possess the intellectual organ, nor apparently any rudiment of the organ, which would enable us to pass by a process of reasoning from one to the other. They appear together, but we do not know why. Were our minds and senses so expanded, strengthened and illuminated as to enable us to see and feel the very molecules of the brain; were we capable of following all their motions, all their groupings, all their electric discharges-if such there be-and were we intimately acquainted with the corresponding states of thought and feeling, we should be as far as ever from the solution of the problem, "how are these physical processes connected with the facts of consciousness?" Let consciousness of love, for example, be associated with a right hand spiral motion of the molecules of the brain, and the consciousness of hate with a left hand spiral motion; we should then know that when we love, the motion is in one direction, and that when we hate, it is in another direction; but the why would remain as unanswerable as before. The utmost that can be affirmed is the association of the two classes of phenomena of whose real bond of union we are in absolute ignorance. And the problem of the connection of mind and body is asserted to be as insoluble in its modern form as it was in the prehistoric ages. Physiological and pathological researches have fully established the

fact that the nervous system, inclusive of the cerebro-spinal and sympathetic, is the physical condition of psychical phenomena, as well as the regulator of the circulatory, nutritive, secretory and excretory processes; and also the apparatus by which the various organs of the body, including its physiological units, are brought into harmonious and co-operative action. Through the crowning centre of this system, the mind's organ, psychical influences are exerted descensively upon the entire organism; and conversely the psychical part of man's nature is influenced ascensively, for better or for worse, by existing bodily conditions. This declaration is exemplified in the experience of every individual, by that general feeling of existence which Condillac has very appropriately styled "the fundamental sentiment of existence," constituting as it were the frontier on which the physiological and psychological forces "like kindred drops mingle into one." Indeed, the physical and psychical are so indissolubly bound together as to constitute a unity in the life of the individual, whether that life be normal or abnormal in its phases, and the general feeling is correspondingly one of comfort or discomfort. It is not less true that morbid emotional states are frequently the causes of functional disorder in the organism, than that emotional disturbances are developed from morbid bodily conditions.

The influence of morbid emotional states on the organic processes is of such frequent occurrence that many instances of such disturbances may be culled from the experience of most practitioners. These vary in degree from a transient interruption of the healthy digestive process to a morbid involvement of the nutritive, secretory and excretory actions of the organism, which in their turn react morbidly upon the mind, until every phase of mentality becomes "sicklied o'er by the pale cast of thought."

I have had for several years under my observation a simple but interesting case of the influence of the psychical upon the physical. When its subject is not annoyed and worried in his business relations, digestion is undisturbed and the appetite may be indulged ad libitum, while his manner is affable to a marked degree. But if any worry or complication in business occurs-presto! comes disordered digestion, requiring a regulation of the dietary, and producing a marked alteration in temper and social bearing.

While emotional excitement may give rise to epilepsy, this neurotic disorder may in turn occasion morbid psychical phenomena, often prominent and distressing in character. In so-called cases of masked

epilepsy, the convulsive seizures are correlated by marked psychical disturbances. The approach of a paroxysm may be foretold by a querulousness, fretfulness and perverseness of temper-an observation of some practical value as suggesting a resort to preventive measures. Chorea has followed violent emotional excitement, and early in the stages psychical disturbances are usually developed, becoming more pronounced as the disorder progresses. Morbid feelings, nursed and cherished, especially in those without mental occupation, may lead to the most distressing results, impairing the circulatory, alimentary, genito-urinary and nervous systems; and the disordered organism, reacting upon the mind, intensifies the emotional disturbance until every sensation assumes a morbid character, and the victim imagines himself a prey to all the manifold ills to which flesh is heir. And as to all such cases, I doubt not you are ready to adopt the solemn invocation, "Good Lord, deliver us!"

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In that vexatious disorder styled hysteria, the most trivial psychical excitant acting upon a nervous system excessively mobile often produces commotion throughout the organism, manifested in derangements of the sensory, motory, circulatory and genito-urinary systems, and also in abnormalities of the secretory and excretory organs. The intellectual and emotional vagaries of this disorder are innumerable, while the visceral troubles are, apparently, very formidable in their array, simulating nearly every malady within the long catalogue of human ills-until we are inclined, with Allan McLane Hamilton, to look upon it as a disease of the devil," and cease to wonder at the credulity of those who believe in demoniac possession and witchcraft. In gout the psychical disturbances are rarely absent, and usually consist in hypochondria, irritability and changeability of mental tone, and lend plausibility to the theory now advanced as to its neurotic nature. Diabetes mellitus is not infrequently accompanied by morbid psychical phenomena, signalized in depression and apathy. In consumption there is generally exhibited a most irrational hope and confidence, which in gastro-hepatic derangements is offset by depression and fancies equally irrational. In neurasthenia, now so unhappily frequent, morbid pyschical phenomena are prominently manifested the indices of a nervous system worn, wasted, and imperfectly nourished. As a consequence the very well-springs of mentality are poisoned, and the mind is tortured with an overshadowing sense of evil, in which unreasonable distrust, apprehension and suspicion distort all the relations of life.

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