The following are the principal points presented: In operations
under inhalation anesthesia the nerve impulses from the trauma
reach every part of the brain--the cerebrum that is apparently
anesthetized as well as the medulla that is known to remain awake--
the proof being the PHYSIOLOGIC exhaustion of and the PATHOLOGIC
change in the nerve-cells. Under ether anesthesia the damage
to the nerve-cells is at least four times greater than under
nitrous oxid. Inhalation anesthesia is, therefore, but a veneer--
a mask that "covers the deep suffering of the patient." The cause
of the exhaustion of the brain is the discharge of nervous energy
in a futile effort to energize the paralyzed muscles in an attempt
to escape from the injury just as if no anesthetic had been given.
The exhaustion is, therefore, of the same nature as that from overexertion,
but if the nerve-paths connecting the field of operation
and the brain be blocked, then there is no discharge of nervous
energy from the trauma, and consequently there is no exhaustion,
however severe or prolonged the operation may be.
Fear is a factor in many injuries and operations. The phenomena
of fear probably are exhibited only by animals whose natural defense
is nerve-muscular. The skunk, the porcupine, the turtle, have little
or no fear. Fear is born of the innumerable injuries which have
been inflicted in the course of evolution. Fear, like trauma,
may cause physiologic exhaustion of and morphologic changes
in the brain-cells. The representation of injury, which is fear,
being elicited by phylogenetic association, may be prevented
by the exclusion of the noci-association or by the administration
of drugs like morphin and scopolamin, which so impair the associational
function of the brain-cells that immunity to fear is established.
Animals whose natural defense is in muscular exertion, among which is man,
may have their dischargeable nervous energy exhausted by fear alone,
or by trauma alone, but most effectively by the combination of both.
What is the mechanism of this discharge of energy? It is the adequate
stimulation of the nociceptors and the physiologic response for the purpose
of self-preservation. According to Sherrington, the nervous system
responds in action as a whole and to but one stimulus at a time.
The integration of the individual as a whole occurs not alone in injury
and fear, but also, though not so markedly, as a result of other
phylogenetic associations, such as those of the chase and procreation.
When adequate stimuli are repeated with such rapidity that the new
stimulus is received before the effect of the previous one has
worn off, a higher maximum effect is produced than is possible
under a single stimulus, however powerful.
Sexual receptors are implanted in the body by natural selection,
and the adequate stimuli excite the nerve-muscular reactions
of conjugation in a manner analogous to the action of the adequate
stimuli of the nociceptors. The specific response of either
the sexual receptors or the nociceptors is at the expense
of the total amount of nervous energy available at the moment.
Likewise in daily labor, which, in the language of evolution,
is the chase, nervous energy is expended. Under the dominance
of fear or injury, however, the integration is most nearly
absolute and probably every expenditure of nervous energy which is
not required for efforts toward self-preservation is arrested;
hence fear and injury drain the cup of energy to the dregs.
This is the potential difference between fear and desire,
between injury and conjugation.
What is the practical application of this? In operative surgery
there is introduced a new principle, which removes from surgery much
of the immediate risk from its trauma by establishing ANOCI-ASSOCIATION;
it places certain of the phenomena of fear on a physical basis;
it explains to us the physical basis for the impairment of the entire
individual under worry or misfortune; it makes evident the physical
results of the daily noci-associations experienced by the individual
as a social unit. On the other hand, it explains the power
of therapeutic suggestion and of other influences which serve
for the time to change the noci-integration; it shows the physical
basis for the difference between hope and despair; it explains
some of the phenomena of Graves' disease, of sexual neurasthenia,
possibly of hay-fever and of the common cold. The principle is probably
equally applicable to the acute infections, in each of which chemical
noci-association gives rise to many of the phenomena of the disease
and it explains their cure by natural immunity and by vaccines.
This hypothesis should teach us to view our patients as a whole;
and especially should it teach the surgeon gentleness. It should
teach us that there is something more in surgery than mechanics,
and something more in medicine than physical diagnosis and drugs.