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PERCY G. STILES,
Assistant Professor of Physiology in Harvard University,
Harvard Medical School, Boston, Mass.
CHEMICAL processes of two oppos- muscles the spaceof time between these
ing orders are conceived to be going extreme phases is longer, say four sec-
on in living cells. Activities of the onds. The heart muscle is automatic,
first type are constructive and dependent the respiratory muscles are not so, but
ultimately on the appropriation of food. actuated by a center in the medulla. It
The converse processes are those in seems to be a physiological principle that
which organic compounds are broken as we pass from simple and elementary
down with release of energy. Such reac- mechanisms to those which are more
tions underlie the production of heat and plex and highly organized the ordinary
work, and, in some measure, the phe- alternation of active and resting periods
nomena of secretion and absorption. It becomes slowed. Muscles that are much
is evident that no organism can remain used under cerebral control appear to
constant as to its mass and potentialities require long intervals of, relative repose.
save as a balance between these two is They are capable of spurts so intense as
closely preserved. A temporary excess to induce long continued depression. It
of destruction (katabolism) over re- is a familiar fact that when the utmost
newal tends to be self-limited and the efforts have been applied to pulling an
disturbance of equilibrium in this direc- ergograph definite fatigue can be demon-
tion may be said to constitute fatigue. strated for an hour or two, even though
When the processes of repair are as the work was done in two or three min-
active as possible and the katabolic utes.
changes still counterbalance them we The mechanisms that stand in closest
have a condition in which the tissue is relation to the cerebrum seem to have
giving its iltaximum performance; it ex- evolved with some conformity to the
pends all it can without progressively diurnal rhythm, their metabolism may be
falling off in capacity. The heart is our continuously above the mean for more
stock illustration of an organ in which than half the twenty-four hours, but for
expenditure and renewal are nicely bal- a considerable part of the night it must
anced; we must note, however, that it be reduced below this average. Where
does not commonly work up to its limit the highest departments of our organiza-
of power. In a rhythmic performance tion are concerned a still longer span may
like that of the heart we may say that intervene between the trough of fatigue
fatigue and complete recovery alternate and the crest of recuperation. The
at very short intervals, usually of less weekly cycle and the beneficent function
than one second. In the breathing of the Sabbath Day are naturally sug-
653
654 THE AMERICAN JOURNAL OF PUBLIC HEALTH
gested. Possibly an annual,decline and employed all the tissues are flooded with
recovery may also be recognized. their waste-products so that there is' a
If we regard fatigue as diminished sympathetic depression of glandular func-
capacity to respond to stimulation-an tion and probably of the cerebral cur-
elevation-of threshold-we at once real- rents which attend the intellectual pro-
ize its protective value. We see how cesses. The massive proportions of the
the interposition of resistance at any muscles must not be forgotten. Their
point inf a co6rdinated system prevents metabolic influence can hinder the subtle
the wearing down of associated struc- performances of the cortical cells-in
tures. Such a resistance appears to be other words, bodily fatigue can unfit one
developed at the junctions between nerve for application to mental tasks-but the
and muscle when they are repeatedly pursuit of mental work cannot develop
traversed. A corresponding obstruction great quantities of end-products that
in, the line of flow is soon esiablished at shall saturate and narcotize the muscles.
the j4nctions (synapses) between the A period of mental stress may make one
minute units of the nervous system. The disinclined to exercise but disinclination
weaker links in the chain are probably is not the same thing as incapacity. If
most easily renewed. In the case of the there is any loss of power in such a case
synapses there seems to be a physical rea- it is probably not represented in the
son for this. They are regions of great muscles but at their seat of government.
attenuation of the conducting substance; Cerebral processes involve but very
protoplasm so organized should burn out small masses of protoplasm and they
quickly if it is the seat of active chemical are doubtless conducted with extreme
decomposition. On the other hand, it economy. Is there a condition which can
should be speedily repaired because it has be accurately described as "mental fa-
most extensive-surface relations with the tigue?" We usually assume that this is
surrounding fluids. a possibility. If, however, we analyze
A new picture of the intimate behavior our own experiences we have to admit
6f muscle under prolonged stimulation as a rule that what we call fatigue in
has been furnished by Pratt of Buffalo. connection with the steady performance
It turns out that what we call a sustained of some monotonous mental operation is
contraction depends on the alternating the tendency to seek relief in novelty-to
activity of the fibers or fiber-bundles com- admit new and irrelevant ideas. Unless
posing the muscle. The contractile ele- the trial is carefully regulated there will
ments in turn bear their part, drop out be elements of eye-strain or postural dis-
of action, and having rested, spring back comfort which are neuromuscular rather
to the work. They fall out because meta- than mental in nature. To be sure, we
bolic changes have caused their thres- eventually need to sleep, but frequently
holds to rise. They resume because they the drowsiness comes sooner to the indo-
have been granted time for at least par- lent than to the diligently working brain.
tial recovery. This principle of working Some of our ablest experimenters doubt
by shifts is favorable to endurance. whether we can surely demonstrate men-
When fatigue is mentioned one thinks tal fatigue.
first of the muscles. this is natural Such a doubt might encourage the
enough. However much the mental may belief that mental processes are definitely
have entered into modern human life metaphysical and make no demand upon
most, people's activity is still measurable the material organization of the brain.
in terms of mechanical work. The mus- This does not follow. It is much easier
cles form about half the body and they to conceive that even the most restricted
account for perhaps four-fifths of its and tedious kind of calculation employs
metabolism. When they are vigorously many neurons in rotation and does not
TYPES OF FATIGUE 655
utilize particular ones so constantly as to prominent part played by inhibitory com-
impair their efficiency. Analogies in this plexes in nervous systems of the highest
field are decidedly clumsy, but the sug- order. Maturity in the individual and
gestion may be ventured that the multiple civilization in the race depend on the
equipment of the cortex is at least re- subjection of many primitive reactions
motely comparable to a -typewriter in to control. A late acquisition is a rela-
which each key is nepessarily idle when tively insecure possession and its loss as
another has its turn. This is a rather a result of many forms of wear and tear
daring transfer to the higher levels of the is too often observed. A nervous sys-
brain of Pratt's picture of the tetanized tem which has suffered this loss is said
muscle in which certain units are contin- to be fatigued though it shows many
ually replacing others. We have said signs of over-activity. It is, in a sense,
that this mode of working prolongs the a defect of the highest organization that
endurance of muscle. If this is true of it does not regularly incline to rest when
a tissue with a high metabolism it may rest is needed. This perversity can be
well nullify fatigue in gray matter where explained in part on the basis of lessened
the rate of disintegration appears to be inhibitory powers, but there is still an-
low. other element which should be given due
Wheti an emotional element enters into consideration. The property referred to
the experience the inception of fatigue is that of canalization.
may be far more obvious than in calm, The utility of this factor in adaptation
straightforward mental work. Excite- td the circumstances of life is readily
ment has its neuromuscular accompani- recognized. In the human nervous sys-
ments and certainly means accelerated tem, far beyond any other, reactions are
metabolism. An important feature is the more easily executed as they are re-
involvementt of glands of internal secre- peated. The principle is that of habit-
tion, notably the adrenal and probably the formation. A path may be pursued by
thyroid. When these have been exer- nerve-currents until its synapses develop
cised depression is to be expected. The resistance to the continued transmission
glands may be exhausted so that for a and the common type of central fatigue
time the delivery of their products is is manifested. But such fatigue is tran-
subnormal. The muscles, having passed sient, and, when it has passed, the net
through a phase of stimulation due to result is a greater facility for conduction
these same products, may enter upon a in the path that has been traversed. This
period of reaction. If we may make any adaptive quality is the basis of accom-
suppositions about the comparative em- plishments of every kind as well as of
ployment of cortical cell-groups in or- mannerisms and unfortunate habits.
derly mental work and in emotional tur- Canalization in the association systems
moil we shall be inclined to assume that must be at the root of scholarly attain-
the latter type of activity is more massive ment as surely as, at lower levels, it is
and probably less varied in distribution the condition of manual skill. It appears
from moment to moment. If it is more that the power to form pathways of
nearly continuous in fixed paths it must ready transmission-in short, the power
be a severer tax than the unemotional to learn-and the establishment of over-
process with its frequent shifting of ruling complexes of an inhibitory order
channels. are alike characteristic of higher as con-
Consideration of what is commonly trasted with lowlier nervous systems. A
called nervous fatigue suggests two fac- simple organism may have a few stand-
tors in the condition which should be ard reactions which will be serviceable
kept in view. The first of these is the in all probable contingencies and no pro-
656 THE AMERICAN JOURNAL OF, PUBLIC HEALTH
-
vision for their repression may be neces- every discharge reacts upon the cells
sary. The need for inhibition comes originally concerned and compels them to
with the development of numerous alter- renew their activity. This seems to be
native reactions and is especially valuable the material concomitant in the numerous
as a check on the canalization cap'acity cases which yield to Freudian psycho-
which tends to make "ruts" in the brain. analysis. The circular flow of nerve-im-
This is rather an academic statement of pulses needs to be iverted to some chan-
something which William James long ago nel of expression that it may no longer
showed to be a most practical matter. return persistently to its own source.
I
Now the picture presented by the vic- Summary. Fatigue, in general, is de-
tim of what we call nervous fatigue sug- pression of working capacity, owing to
gests two difficulties. One is the want a katabolism running above the average
of inhibitory control. This is exhibited for the tissue. In muscle it is just this.
in the familiar unrest, and, on the affer- Muscular fatigue, because of the large
ent side, as hypersensitiveness. The sec- masses of active protoplasm involved,
ond feature of the trouble is canalization. can extend its influence to other systems.
The "tired" nervous system has formed In narrowly localized brain activity the
bad habits. These are discovered not metabolic process cannot be large and
only in conduct but in unhappy trains of true cerebral fatigue is probably far less
thought, incessant anxiety and self-pity. common than is supposed. The use of
Important as it may be in such cases to different cell-groups in rotation may min-
build up the general health, we can see imize the demand upon each member.
that the critical need is discipline. Change The ordinary cause of diminishing
of scene and sanatorium life may be mental efficiency is the desire for a
chiefly useful as they favor the disruption change. In a reasonably trained system
of the nerve-paths so excessively em- this is a wholesome impulse. What we
ployed. Psychotherapy may effect this. call nervous fatigue, referring to a con-
This application may be in the abstract dition which is pathological and often of
terms of some idealistic system or the long duration, is due primarily to less-
very same jostling from the grooves may ened inhibition. Many of its features
be accomplished with a measure of harsh- are symptomatic of bad habits established
ness. The more insight one gains into in the ill-controlled system. Unusual
the workings of the nervous apparatus outflowing currents may pervert the
the less one is surprised by the compara- action of the endocrine organs. Recov-
tively rapid readjustments which may
ery from' nervous fatigue is less a matter
often be accomplished in it. Perhaps the
most injurious canalizations have the of correcting the metabolism than of
character of closed circuits in which desirable habit formation.