260 MAN --AN ADAPTIVE MECHANISM 



by the frequent occurrence of pneumonia in cases of 

 localized pleurisy, in which pain causes an inhibition of 

 free excursion in the part of the chest which is in- 

 volved. The resultant pneumonia usually occurs in 

 that portion of the lungs whose free action is inhibited. 

 After gall bladder operations, pneumonia begins usually 

 not in the left but in the right lobe, whereas were 

 the pneumonia embolic in its origin, the lobes would 

 probably fare alike. 



The diminution in the number of cases of postopera- 

 tive pneumonia since the adoption of the technique of 

 anociation is final proof of this theory as to its cause. 

 Because of the lack of local tenderness in the field of 

 operation produced by the technique of the operation 

 itself, and by the postoperative nerve blocking with 

 quinin and urea hydrochlorid, there is diminished or 

 no inhibition of the respiratory excursions. This also, 

 without doubt, explains the reduced mortality of opera- 

 tions for umbilical hernia performed with the transverse 

 incision (Mayo). 



