ANOCIATION 257 



be so performed that no strong traumatic stimulus 

 reaches the brain, either during or after operation, then 

 the threshold to the cerebral arc from the wound will 

 not be lowered, and the scar will yield no abnormal 

 pain. 



Postoperative or Posttraumatic Nervousness 



A lowered threshold, resulting from some overwhelm- 

 ing stimulus which predisposes the kinetic system to 

 an uncontrollable discharge of energy in response to 

 trifling stimuli, may explain many abnormal conditions, 

 among them postoperative neurasthenia, which is 

 largely prevented by anociation. It is an unhappy 

 reflection upon surgery that the general public has come 

 to expect that a state of nervous derangement, which 

 may last from several months to a year or more, is an 

 inevitable sequel to operations. 



When, in the night, one is suddenly awakened by 

 the consciousness of an impending peril, the brain 

 threshold is immediately lowered, apparently as an 

 adaptation for the more swift and accurate perception 

 of the danger. Hearing, sight and sense of touch are ab- 

 normally acute. A similar state of universally lowered 

 threshold exists after the receipt of a crushing physical 

 injury. In this tense state, minor stimuli produce 

 major effects, and the individual, in common parlance, 

 is " nervous." In an operation under inhalation anes- 

 thesia alone, the unconscious brain has been tortured 

 nearly as much as the conscious brain would be under 

 the same amount of injury and the resultant effect upon 

 the brain threshold is the same. It is not strange that 

 from such an ordeal the patient emerges " nervous" 



