40 THE ACTION OF THE LIVING CELL 



when subjected to surgical procedures, animals or 

 patients are more apt to pass into a state of shock if 

 the anesthesia is unduly prolonged. This is readily 

 understood when we recall that our experiments have 

 shown that both anesthetic and trauma are able to 

 effect a liberation of the shock-toxin, cytost. Hence, 

 when operated upon, an anesthetized animal is sub- 

 jected to the action of a higher concentration of cytost 

 than in the case of subjection to either of the experi- 

 mental methods alone. This state of afifairs, then, is 

 closely analogous to that previously postulated to 

 explain the marked susceptibility to surgical shock 

 of patients with carcinoma of the stomach. 



In this connection it is of interest to note that such 

 cases when subjected to operation are subjected to 

 the action of cytost liberated in three ways: by the 

 carcinoma, by the anesthetic, and by the operative pro- 

 cedure — a truly formidable combination of factors 

 calculated to liberate cytost. 



At this point it is perhaps proper to stress the fact 

 that in general the subjection of animals to two or more 

 harmful agencies, as in the examples just considered, 

 may lead to a synergism, or apparent potentiation of 

 one another. Thus, in 1900, the writer found that ani- 

 mals which had been in shock were easily susceptible 

 alike to the action of Staphylococcus albus, Staphylo- 

 coccus Pyogenes aureus, and Bacillus coli, whereas 

 injection of cultures of the first and third of these 

 organisms into normal animals yielded only negative 

 results. 



It follows therefore that in the presence of a high 

 concentration of cytost resulting from the action of 

 the agency utilized to produce shock, the virulence of 



