By the law of phylogenetic association, we are now prepared
to make a practical application of the principles of the discharge
of nervous energy. In the case of a surgical operation, if fear
be excluded and if the nerve-paths between the field of operation
and the brain be blocked with cocain,[*] no discharge of energy will be
caused by the operation; hence no shock, no exhaustion, can result.
Under such conditions the nervous system is protected against
noci-association, resulting from noci-perception or from an adequate
stimulation of nociceptors. The state of the patient in whom all
noci-associations are excluded can be described only by coining
a new word. That word is "anoci-association" (Fig. 14).
[*] See footnote, page 4.@@@
The difference between anesthesia and anoci-association is that,
although _inhalation anesthesia_ confers the beneficent loss of
consciousness and freedom from pain, it does not prevent the nerve
impulses from reaching and influencing the brain, and therefore does
not prevent surgical shock nor the train of later nervous impairments
so well described by Mumford. _Anoci-association_ excludes fear,
pain, shock, and postoperative neuroses. _Anoci-association_ is
accomplished by combining the special management of patients
(applied psychology), morphin, inhalation anesthesia,
and local anesthesia.
We have now presented in summary much of the mass of experimental
and clinical evidence we have accumulated in support of our
principal theme, which is that the discharge of nervous energy is
accomplished in accordance with the law of phylogenetic association.
If this point seems to have been emphasized unduly, it is because
we expect to rear upon this foundation a clinical structure.
How does this hypothesis apply to surgical operations?
Prevention of Shock by the Application of the Principle of
Anoci-association
Upon this hypothesis a new principle in operative surgery is founded, _i.
e_., operation during the state of _anoci-association_. Assuming that
no unfavorable effect is produced by the anesthetic and that there is
no hemorrhage, the cells of the brain cannot be exhausted in the course
of a surgical operation except by fear or by trauma, or by both.
Fear may be excluded by narcotics and special management until
the patient is rendered unconscious by inhalation anesthesia.
Then if, in addition to inhalation anesthesia, the nerve-paths
between the brain and the field of operation are blocked with
cocain,[*] the patient will be placed in the beneficent state of
_anoci-association_, and at the completion of the operation will be
as free from shock as at the beginning. In so-called "fair risks"
such precautions may not be necessary, but in cases handicapped
by infections, by anemia, by previous shock, and by Graves'
disease, etc., anoci-association may become vitally important.
[*] See footnote, page 4.@@@