the origin and nature of emotions-第6部分

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　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reciprocal　goading　may　continue　until　either　the　brain　or　the　thyroid　is　destroyed。　If　the　original　noci…stimulus　is　withdrawn　before　the　fear　of　the　disease　becomes　too　strong；　and　before　too　much　injury　to　the　brain　and　the　thyroid　has　been　inflicted；　a　spontaneous　cure　may　result。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　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　varia