the origin and nature of emotions-第7节

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ered　irreparable　damage。　There　are　still　many　missing　links　in　the　solution　of　this　problem；　and　the　foregoing　hypotheses　are　not　offered　as　final；　although　from　the　viewpoint　of　the　surgeon　many　of　the　phenomena　of　this　disease　are　explicable。


Sexual…Neurasthenia


The　state　of　sexual　neurasthenia　is　in　many　respects　analogous　to　that　of　Graves'　disease。　　In　the　sexual　reflexes；　summation　leads　to　a　hyperexcitability　by　psychic　and　mechanical　stimuli　of　a　specific　type　which　is　analogous　to　the　hyperexcitability　in　Graves'　disease　under　trauma　and　fear；　the　explanation　of　both　conditions　is　based　on　the　laws　of　the　discharge　of　energy　by　phylogenetic　association　and　summation。　　It　would　be　interesting　to　observe　the　effect　of　interrupting　the　nerve　impulses　from　the　field　of　the　sexual　receptors　by　injections　of　alcohol；　or　by　other　agencies；　so　as　to　exclude　the　associational　stimuli　until　the　nervous　mechanism　has　again　become　restored　to　its　normal　condition。　Interpretation　of　Some　of　the　Phenomena　of　Certain　Diseases　of　the　Abdomen　in　Accordance　with　the　Hypothesis　of　Phylogenetic　Association


The　law　of　phylogenetic　association　seems　to　explain　many　of　the　phenomena　of　certain　lesions　in　the　abdominal　cavity。　The　nociceptors　in　the　abdomen；　like　nociceptors　elsewhere；　have　been　established　as　a　result　of　some　kind　of　injury　to　which　during　vast　periods　of　time　this　region　has　been　frequently　exposed。　On　this　premise；　we　should　at　once　conclude　that　there　are　no　nociceptors　for　heat　within　the　abdomen　because；　during　countless　years；　the　intra…abdominal　region　never　came　into　contact　with　heat。　That　this　inference　is　correct　is　shown　by　the　fact　that　the　application　of　a　thermocautery　to　the　intestines　when　completing　a　colostomy　in　a　conscious　patient　is　absolutely　painless。　One　would　conclude　also　that　there　are　no　touch　receptors　in　the　abdominal　viscera；　and　therefore　no　sense　of　touch　in　the　peritoneum。　Just　as　the　larynx；　the　ear；　the　nose；　the　sole　of　the　foot；　and　the　skin　have　all　developed　the　specific　type　of　nociceptors　which　are　adapted　for　their　specific　protective　purposes；　and　which；　when　adequately　stimulated；　respond　in　a　specific　manner　in　accordance　with　the　law　of　phylogenetic　association；　so；　the　abdominal　viscera　have　developed　equally　specific　nociceptors　as　a　protection　against　specific　nocuous　influences。　　The　principal　harmful　influences　to　which　the　abdominal　viscera　have　been　exposed　during　vast　periods　of　time　are　deep　tearing　injuries　by　teeth　and　claws　in　the　innumerable　struggles　of　our　progenitors　with　each　other　and　with　their　enemies　（Fig。　9）；　peritonitis　caused　by　perforations　of　the　intestinal　tract　from　ulcers；　injuries；　appendicitis；　gall…stones；　etc。；　and　overdistention　of　the　hollow　viscera　by　various　forms　of　obstruction。　Whatever　may　be　the　explanation；　it　is　a　fact　that　the　type　of　trauma　which　results　from　fighting　corresponds　closely　with　that　which　causes　the　most　shock　in　the　experimental　laboratory。　Division　of　the　intestines　with　a　sharp　knife　causes　no　pain；　but　pulling　on　the　mesentery　elicits　pain。　　Ligating　the　stump　of　the　appendix　causes　sharp；　cramp…like　pains。　　Sharp　division　of　the　gall…bladder　causes　no　pain；　but　distention；　which　is　the　gall…bladder's　most　common　pathologic　state；　produces　pain。　Distention　of　the　intestine　causes　great　pain；　but　sharp　cutting　or　burning　causes　none。　　In　the　abdominal　viscera；　as　in　the　superficial　parts；　nociceptors　have　presumably　been　developed　by　specific　harmful　influences　and　each　nociceptor　is　open　to　stimulation　only　by　a　stimulus　of　the　particular　type　that　produced　it。

As　a　result　of　the　excitation　of　nociceptors；　with　which　pain　is　associated；　the　routine　functions；　such　as　peristalsis；　secretion；　and　absorption　are　dispossessed　from　the　control　of　their　respective　nervous　mechanisms；　just　as　they　are　inhibited　by　fear。　　This　hypothesis　explains　the　loss　of　weight；　the　lassitude；　the　indigestion；　the　constipation；　and　the　many　alterations　in　the　functions　of　the　various　glands　and　organs　of　the　digestive　system　in　chronic　appendicitis。　It　readily　explains　also　the　extraordinary　improvement　in　the　digestive　functions　and　the　general　health　which　follows　the　removal　of　an　appendix　which　is　so　slightly　altered　physically　that　only　the　clinical　results　could　persuade　one　that　this　slight　change　could　be　an　adequate　cause　for　such　far…reaching　and　important　symptoms。　This　hypothesis　explains　certain　gall…bladder　phenomena　likewise；　indigestion；　loss　of　weight；　disturbed　functions；　etc。；and　it　may　supply　the　explanation　of　the　disturbance　caused　by　an　active　anal　fissure；　which　is　a　potent　noci…associator；　and　the　consequent　disproportionate　relief　after　the　trivial　operation　for　its　cure。　Noci…association　would　well　explain　also　the　great　functional　disturbances　of　the　viscera　which　immediately　follow　abdominal　operations。

Postoperative　and　traumatic　neuroses　are　at　once　explained　on　the　ground　of　noci…association；　the　resulting　strain　from　which；　upon　the　brain…cells；　causes　in　them　physical　lesions。　If　one　were　placed　against　a　wall　and　were　looking　into　the　gun　muzzles　of　a　squad　of　soldiers；　and　were　told　that　there　were　nine　chances　out　of　ten　that　he　would　not　be　killed　outright　when　the　volley　was　fired；　would　it　help　him　to　be　told　that　he　must　not　be　afraid？　Such　an　experience　would　be　written　indelibly　on　his　brain。　This　corresponds　closely　to　the　position　in　which　some　surgical　patients　are　placed。　　In　railway　wrecks；　we　can　readily　understand　the　striking　difference　between　the　after…effects　in　the　passengers　who　were　conscious　at　the　time　of　the　accident　and　those　who　were　asleep　or　drunk。　In　the　latter　the　noci…perceptors　and　receptors　were　not　aroused；　hence　their　immunity　to　the　nervous　shock。　　In　the　functional　disturbances　of　the　pelvic　organs；　association　and　summation　may　play　a　large　role。　On　this　hypothesis　many　cases　of　neurasthenia　may　well　be　explained。　From　the　behavior　of　the　individual　as　a　whole　we　may　well　conclude　that　summation　is　but　a　scientific　expression　for　〃nagging。〃　Many　other　pathologic　phenomena　may　be　explained　in　a　similar　manner。　Thus　we　can　understand　the　variations　in　the　gastric　analyses　in　a　timid　patient　alarmed　over　his　condition　and　afraid　of　the　hospital。　He　is　integrated　by　fear；　and　as　fear　takes　precedence　over　all　other　impulses；　no　organ　functionates　normally。　　For　the　same　reason；　one　sees　animals　in　captivity　pine　away　under　the　dominance　of　fear。　The　exposure　of　a　sensitive　brain　to　the　naked　possibility　of　death　from　a　surgical　operation　may　be　compared　to　uncovering　a　photographic　plate　in　the　bright　sunlight　to　inspect　it　before　putting　it　in　the　camera。　This　principle　explains；　too；　the　physical　influence　of　the　physician　or　surgeon；　who；　by　his　PERSONALITY；　inspires；　like　a　Kocher；　absolute　confidence　in　his　patient。　　The　brain；　through　its　power　of　phylogenetic　association；　controls　many　processes　that　have　wholly　escaped　from　the　notice　of　the　〃practical　man。〃　　It　is　in　accordance　with　the　law　of　association　that　a　flower；　a　word；　a　touch；　a　cool　breeze；　or　even　the　thought　of　a　fishing　rod　or　of　a　gun；　is　helpful。　On　the　contrary；　all　suggestions　of　despair　or　misfortune　a　corrugated　brow；　the　gloomy　silence　of　despair；　or　a　doubtful　word　are　equally　depressing。　　In　like　manner；　one　could　add　many　illustrations　of　the　symbolism　that　governs　our　daily　lives。　Thus　we　see　that　through　the　laws　of　inheritance　and　noci…association；　we　are　able　to　read　a　new　meaning　into　the　clinical　phenomena　of　various　diseases。


Observations　on　Patients　whose　Associational　Centers　are　Dulled；　and　on　Diseases　and　Injuries　of　Regions　not　Endowed　with　Nociceptors


Reversing　the　order　of　our　reasoning；　let　us　now　glance　at　the　patient　who　is　unconscious　and　who；　therefore；　has　lost　much　of　the　power　of　association。　　His　mouth　is　usually　dry；　the　digestive　processes　are　at　a　low　ebb；　the　aroma　of　food　causes　no　secretion　of　saliva；　tickling　the　nose　causes　no　sneezing；　he　catches　no　cold。　The　laryngeal　reflex　is　lost　and　food　may　be　quietly　inhaled；　the　entire　process　of　metabolism　is　low。　　The　contrast　between　a　man　whose　associational　centers　are　keen　and　a　man　in　whom　these　centers　are　dulled　or　lost　is　the　contrast　between　life　and　death。

In　accordance　with　the　law　of　adaptation　through　natural　selection；　phylogeny；　and　association；　one　would　expect　no　pain　in　abscess　of　the　brain；　in　abscess　of　the　liver；　in　pylephlebitis；　in　infection　of　the　hepatic　vessels；　in　endocarditis。　This　law　explains　why　there　are　no　nociceptors　for　cancer；　while　there　are　active　nociceptors　for　the　acute　infections。　It　is　because　nature　has　no　helpful　response　to　offer　against　cancer；　while　in　certain　of　the　acute　pyogenic　infections　the　nociceptors　force　the　beneficent　physiologic　rest。

Could　we　dispossess　ourselves　of　the　shackles　of　psychology；　forget　its　confusing　nomenclature；　and　view　the　human　brain；　as　Sherrington　has　said；　〃as　the　organ　of；　and　for　the　adaptation　of　nervous　reaction；〃　many　clinical　phenomena　would　appear　in　a　clearer　light。


Natural　Selection　and　Chemical　Noci…association　in　the　Infections


Thus　far　we　have　considered　the　behavior　of　the　individ