176 GLANDS IN HEALTH AND DISEASE 



complish the desired result, the conditions which 

 produced the shock are ameliorated or eliminated, 

 and the circulation is supported. For the details 

 the reader must be referred to the book. One fur- 

 ther quotation must suffice. "By an assuring pre- 

 operative treatment; by the definite dulling of the 

 nerves through the administration of a narcotic; 

 by a non-suffocating odorless anesthetic ; by a local 

 anesthetic to cut off all afferent impulses during 

 the course of the operation ; by a second local anes- 

 thetic of lasting effect to protect the patient during 

 the painful postoperative hours ; by gentle manipu- 

 lation and sharp dissection, by the combination of 

 all these methods the patient is protected from 

 damage from every factor excepting those which 

 exist in the diseased condition from which relief 

 is sought." * 



*How successful this method is may be gauged from the fact 

 that Dr. Crile can operate on a patient suffering from exophthal- 

 mic goiter without materially increasing his pulse rate. "It was 

 in large measure the study of the preoperative and postoperative 

 course of cases of Graves's disease which led to the enunciation 

 of the kinetic theory of shock and the development of the shock- 

 less operation. ... By the extension of employment of anocia- 

 tion and asepsis, the mortality in the last 6,261 operations at 

 Lakeside Hospital (Cleveland) has been reduced to 1.6 per cent. 

 Our series have included 58 colostomies and resections of the 

 rectum and large intestine for cancer, with one death, and 70 

 resections of the stomach and gastro-enterostomies for cancer 

 and ulcer of the stomach, with one death. Anociation and 

 asepsis have made possible a series of 227 consecutive thyroid- 

 ectomies and 180 consecutive ligations, that is, 407 conseci5tive 

 thyroid operations for hyperthyroidism without a death. These 

 are not selected cases. No patient was rejected and many were 

 dying. Among the last 500 thyroidectomies, there have been five 



