We have now presented some evidence that nervous energy is discharged by the adequate stimulation of one or more of the various receptors that have been developed in the course of evolution. In response to an adequate stimulus, the nervous system is integrated for a specific purpose by the stimulated receptor, and but one stimulus at a time has possession of the final common path— the nerve mechanisms for action. The most numerous receptors are those for harmful contact; these are the nociceptors. The effect of the adequate stimulus of a nociceptor is like that of pressing an electric button that sets great machinery in motion.
With this conception, the human body may be likened to a musical instrument—an organ—the keyboard of which is composed of the various receptors, upon which environment plays the many tunes of life; and written within ourselves in symbolic language is the history of our evolution. The skin may be the "Rosetta Stone" which furnishes the key.
Anoci-association
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.@@@