CHAPTER IX 



ANOCIATION l 



IN the prevention of surgical shock by anociation 

 we have the most convincing test of the practical 

 application of the kinetic theory. 2 In surgical shock 

 the kinetic system is driven to the point of exhaustion 

 by an acute overwhelming activation leading to acute 

 acidosis, the result either of physical injury alone, or of 

 physical injury in combination with preoperative fear. 

 Since shock differs only in degree from any other acti- 

 vation of the kinetic system by physical or chemical 

 stimuli, the prevention of shock must depend upon the 

 possibility of preventing or diminishing the number and 

 intensity of the stimuli which enter the brain by way of 

 either contact or distance ceptors. (Figs. 54, 55, 56.) 

 Such an isolation of the brain is secured in anociation 

 (absence of harmful association) by dulling preopera- 

 tive sensibility to all psychic impressions by personal 

 management and, if required, by a preoperative ad- 

 ministration of sedatives ; by general inhalation anes- 

 thesia, which blocks the distance ceptors; and by 

 blocking the afferent nerve paths in the field of opera- 

 tion by means of local anesthesia. 



1 Hereafter the term anociation will be substituted for the more 

 cumbersome expression anoci association. 



2 1 wish to state here that the statement made by certain writers 

 that I have ever proposed an inclusive vaso-motor theory of shock is 

 erroneous. 



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