the origin and nature of emotions-第6节

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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。@@@


Graves'　Disease


By　applying　the　principle　of　the　discharge　of　nervous　energy　by　phylogenetic　association；　and　by　making　the　additional　hypothesis　that　in　the　discharge　of　nervous　energy　the　thyroid　gland　is　stimulated　through　the　nervous　system；　we　can　explain　many　of　the　phenomena　of　Graves'　disease　and　may　possibly　discover　some　of　the　factors　which　explain　both　its　genesis　and　its　cure。

In　the　wild　state　of　animal　life　in　which　only　the　fittest　survive　in　the　struggle　for　existence；　every　point　of　advantage　has　its　value。　　An　animal　engaged　in　battle　or　in　a　desperate　effort　to　escape　will　be　able　to　give　a　better　account　of　itself　if　it　have　some　means　of　accelerating　the　discharge　of　energy　some　influence　like　that　of　pouring　oil　upon　the　kindling　fire。　There　is　evidence；　though　perhaps　it　is　not　conclusive；　that　such　an　influence　is　exerted　by　the　thyroid　gland。　In　myxedema；　a　condition　characterized　by　a　lack　of　thyroid　secretion；　there　is　dulness　of　the　reflexes　and　of　the　intellect；　a　lowered　muscular　power；　and　generally　a　sluggish　discharge　of　energy。　In　Graves'　disease　there　is　an　excessive　production　of　thyroid　secretion。　In　this　disease　the　reflexes　are　increased；　the　discharge　of　energy　is　greatly　facilitated；　and　metabolism　is　at　a　maximum。　The　same　phenomena　occur　also　after　the　administration　of　thyroid　extract　in　large　doses　to　normal　subjects。　　In　the　course　of　sexual　activities　there　is　an　increased　action　of　the　thyroid；　which　is　indicated　by　an　increase　in　its　size　and　vascularity。　That　in　fear　and　in　injury　the　thyroid；　in　cases　of　Graves'　disease；　is　probably　stimulated　to　increased　activity　is　indicated　by　the　increased　activity　of　the　thyroid　circulation；　by　an　increase　in　the　size　of　the　gland；　by　the　histologic　appearance　of　activity　in　the　nuclei　of　the　cells；　and　by　an　increase　of　the　toxic　symptoms。　Finally；　Asher　has　stated　that　electric　stimulation　of　the　nerve　supply　of　the　thyroid　causes　an　increased　secretion。　　The　origin　of　many　cases　of　Graves'　disease　is　closely　associated　with　some　of　the　causes　of　the　discharge　of　nervous　energy；　depressive　influences　especially；　such　as　nervous　shocks；　worry　and　nervous　strain；　disappointment　in　love；　business　reverses；　illness　and　death　of　relatives　and　friends。　The　association　of　thyroid　activity　with　procreation　is　well　known；　hence　the　coincidence　of　a　strain　of　overwork　or　of　fear　with　the　sexual　development　of　maturing　girls　is　obviously　favorable　to　the　incidence　of　Graves'　disease。　　The　presence　of　a　colloid　goiter　is　a　suitable　soil　for　the　development　of　Graves'　disease；　and　I　fully　recognize　also　the　evidence　that　infection　or　auto…intoxication　may　be　contributing　factors　and　must　be　assigned　their　role。

I　have　never　known　a　case　of　Graves'　disease　to　be　caused　by　success　or　happiness　alone；　or　by　hard　physical　labor　unattended　by　psychic　strain；　or　to　be　the　result　of　energy　voluntarily　discharged。　Some　cases　seem　to　have　had　their　origin　in　overdosage　with　thyroid　extract　in　too　vigorous　an　attempt　to　cure　a　colloid　goiter。　One　of　the　most　striking　characteristics　of　Graves'　disease　is　the　patient's　loss　of　control　and　his　increased　susceptibility　to　stimuli；　especially　to　trauma　and　to　fear　and　to　the　administration　of　thyroid　extract。　　It　has　been　shown　that　the　various　causes　of　the　discharge　of　nervous　energy　produce　alterations　in　the　nervous　system　and　probably　in　the　thyroid　gland。　　This　is　especially　true　of　the　fear　stimulus；　and　has　been　clearly　demonstrated　in　the　brains　of　rabbits　which　had　been　subjected　to　fear　alone　（Fig。　13）。　Of　special　interest　was　the　effect　of　daily　fright。　In　this　case　the　brain…cells　showed　a　distinct　change；　although　the　animal　had　been　subjected　to　no　fear　for　twenty…four　hours　before　it　was　killed　（Fig。　13　C。　Now；　a　great　distinction　between　man　and　the　lower　animals　is　the　greater　control　man　has　acquired　over　his　actions。　This　quality　of　control；　having　been　phylogenetically　most　recently　acquired；　is　the　most　vulnerable　to　various　NOCUOUS　influences。　The　result　of　a　constant　noci…integration　may　be　a　wearing…out　of　the　control　cells　of　the　brain。　　In　a　typical　case　of　Graves'　disease　a　marked　morphologic　change　in　the　brain…cells　has　been　demonstrated　（Fig。　15）。　As　has　been　previously　stated；　the　origin　of　many　cases　of　Graves'　disease　is　associated　with　some　noci…influence。　If　this　influence　causes　stimulation　of　both　the　brain　and　the　thyroid；　its　excessive　action　may　cause　impairment　of　the　brain　and　also　hyperplasia　of　the　thyroid。　As　self…control　is　impaired；　fear　obtains　an　ascendency　and；　_pari　passu_；　stimulates　the　thyroid　still　more　actively　（Fig。　16）。　Finally；　the　fear　of　the　disease　itself　becomes　a　noci…stimulus。　As　the　thyroid　secretion　causes　an　increase　in　the　facility　with　which　nervous　energy　is　discharged；　a　pathologic　reciprocal　interaction　is　established　between　the　brain　and　the　thyroid。　The　effect　of　the　constantly　recurring　stimulus　of　the　noci…influence　is　heightened　by　summation。　　This　reciprocal　goading　may　continue　until　either　the　brain　or　the　thyroid　is　destroyed。　If　the　original　noci…stimulus　is　withdrawn　before　the　fear　of　the　disease　becomes　too　strong；　and　before　too　much　injury　to　the　brain　and　the　thyroid　has　been　inflicted；　a　spontaneous　cure　may　result。　Recovery　may　be　greatly　facilitated　by　complete　therapeutic　rest。　A　cure　implies　the　return　of　the　brain…cells　to　their　normal　state；　with　the　reestablishment　of　the　normal　self…control　and　the　restoration　of　the　thyroid　to　its　normal　state；　when　the　impulses　of　daily　life　will　once　more　have　possession　of　the　final　common　path　and　the　noci…influence　will　be　dispossessed。　The　discovery　of　the　real　cause　of　a　given　case　of　Graves'　disease　is　frequently　difficult　because　it　may　be　of　a　painful　personal　nature。　Of　extreme　interest　is　the　fact　that；　in　the　acute　stage；　the　patient　may　be　unable　to　refer　to　the　exciting　cause　without　exhibiting　an　exacerbation　of　the　symptoms　of　the　disease。　I　presume　no　case　should　be　regarded　as　cured　until　reference　can　be　made　to　its　cause　without　an　abnormal　reaction。　It　has　been　established　that　in　Graves'　disease　injury　to　any　part　of　the　body；　even　under　inhalation　anesthesia；　causes　an　exacerbation　of　the　disease。　　Fear　alone　may　cause　an　acute　exacerbation。　These　acute　exacerbations　are　frequently　designated　〃hyperthyroidism〃　and　are　the　special　hazard　of　operation。

In　applying　the　principle　of　anoci…association　in　operations　on　patients　with　Graves'　disease　there　is　scarcely　a　change　in　the　pulse；　in　the　respiration；　or　in　the　nervous　state　at　the　close　of　the　operation。　I　know　no　remedy　which　can　obviate　the　effect　of　the　inflowing　stimuli　from　the　wound　after　the　cocain＇*＇　has　worn　off。＇t＇　It　is　necessary；　therefore；


Beats　70　80　90　100　110　120



Ether　*******　********　********　********　********



N2O　*******　********　********　********　*



Anoci。　　*******　********　********　**　not　to　venture　too　far　in　serious　cases。　　Since　the　adoption　of　this　new　method　（anoci…association）　my　operative　results　have　been　so　vastly　improved　that　I　now　rarely　regard　any　case　of　Graves'　disease　as　inoperable；　at　least　to　the　extent　of　contraindicating　a　double　ligation　（Fig。　17）。


＇*＇　See　footnote；　page　4。@@@

＇t＇　In　later　papers　and　in　〃Anoci…association〃　（Crile　and　Lower）　methods　of　combating　postoperative　hyperthyroidism　are　fully　discussed。


If　we　believe　that；　in　accordance　with　the　law　of　phylogenetic　association；　a　continuous　stimulation　of　both　the　brain　and　the　thyroid　gland；　accelerated　by　summation；　plays　a　role　in　the　establishment　of　the　pathologic　interaction　seen　in　Graves'　disease；　then　it　is　but　the　next　step　to　assume　that　if　the　nerve　connection　between　the　brain　and　the　thyroid　be　severed；　or　if　the　lobe　be　excised　and　the　patient　reinforced　by　a　sojourn　in　a　sanatorium　or　in　some　environment　free　from　former　noci…associations；　he　may　be　restored　to　normal　health；　provided　that　the　brain…cells；　the　heart；　or　other　essential　organs　have　not　suffered　irreparable　damage。　There　are　still　many　missing　links　in　the　solution　of　this　problem；　and　the