ANOCIATION 255 



The loss of water by vomiting, the diminished intake 

 of water and the failure of water absorption cause a 

 rapid shrinkage of the soft parts which is especially 

 noted in the face, while the increased blood supply to 

 the intestines, combined with the diminished intake of 

 water causes a rapid diminution of the pulse volume. 

 The loss of water is followed also by a diminished vol- 

 ume of urine. At the same time metabolism is in- 

 creased, and as a result the acid by-products and the 

 H-ion concentration of the blood are increased. The 

 increased H-ion concentration of the blood stimulates 

 the respiratory center. The loss of water and the in- 

 creased H-ion concentration cause thirst. In this pic- 

 ture of the gamut of the phenomena of peritonitis we 

 see that all are logical results of the activity of a local, 

 self-defense mechanism against infection. Every pen- 

 etration of the peritoneum initiates this protective 

 mechanism whether there is infection or not hence 

 abdominal operations are usually followed by gas pain. 



If that portion of the brain through which this 

 adaptive response is made be kept in ignorance of the 

 incision into the peritoneum by progressive novocain 

 blocking during the operation and by quinin and urea 

 hydrochlorid blocking to prevent nerve impulses from 

 reaching the brain after the operation, there should be 

 and there is diminished or no gas pain. But if, 

 on the other hand, a single nerve pathway escape the 

 blocking and communicate with the brain, there is gas 

 pain, as would be expected. 



The same principle is illustrated in the effective 

 treatment of peritonitis by large physiologic doses of 

 opium the Alonzo Clark treatment. This treatment, 



