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Effect Upon the Output of Energy of Impaired or Lost Function of Each of the Several Links in the Kinetic Chain

(1) The Brain.—In cerebral softening we may find all the organs of the body comparatively healthy excepting the brain. As the brain is physically impaired it cannot normally stimulate other organs to the conversion of latent energy into heat or into motion, but, on the contrary, in these cases we find feeble muscular and intellectual power. I believe also that in patients with cerebral softening, infections such as pneumonia show a lower temperature range than in patients whose brains are normal.

(2) The Adrenals.—In such destructive lesions of the adrenals as Addison's disease one of the cardinal symptoms is a subnormal temperature and impaired muscular power. Animals upon whom double adrenalectomy has been performed show a striking fall in temperature, muscular weakness,—after adrenalectomy the animal may not be able to stand even,—and progressive chromatolysis.

(3) The Liver.—When the function of the liver is impaired by tumors, cirrhosis, or degeneration of the liver itself, then the entire energy of the body is correspondingly diminished. This diminution of energy is evidenced by muscular and mental weakness, by diminished response and by gradual loss of efficiency which finally reaches the state of asthenia.

(4) The Muscles.—It has been observed clinically that if the muscles are impaired by long disuse, or by a disease such

as myasthenia gravis, then the range of production of both heat and motion is below normal. This is in agreement with the experimental findings that anesthetics, curare, or any break in the muscle-brain connection causes diminished muscular and heat production.

(5) The Thyroid.—In myxedema one of the cardinal symptoms is a persistently subnormal temperature and, though prone to infection, subjects of myxedema show but feeble febrile response and readily succumb. This clinical observation is strikingly confirmed by laboratory observations; normal rabbits subjected to fear showed a rise in temperature of from one to three degrees, while two rabbits whose thyroids had been previously removed and who had then been subjected to fright showed much less febrile response. Myxedema subjects show a loss of physical and mental energy which is proportional to the lack of thyroid. Deficiency in any of the organs of the kinetic chain causes alike loss of heat, loss of muscular and emotional action, of mental power, and of the power of combating infections—the negative evidence thus strongly supports the positive. By accumulating all the evidence we believe we are justified in associating the brain, the adrenals, the thyroid, the muscles, and the liver as vital links in the kinetic chain. Other organs play a rôle undoubtedly, though a minor one.