The occurrence of nervous and mental symptoms of varying degree is common in the course of visceral disease in general and in disease of the heart, the lungs and the abdominal organs in particular. These symptoms usually occur in fairly advanced stages of cardiovascular-renal disease, in pulmonary disease and in various gastro-intestinal abnormalities, being usually reactions on the part of the central nervous system to the toxic or metabolic changes produced by the progressive visceral condition. The character and intensity of the nervous symptoms further depend on the previous personality of a given patient; abnormal tendencies appear accentuated or latent psychotic tendencies become activated under the stress and strain of the existing physical disability. The nervous manifestations in these cases are further modified by the social and economic circumstances of the patient, and psychogenic factors play a large rôle in the symptomatology of these organic cases.
The character of the