50 SURGICAL SHOCK 



with some degree of confidence for the future. And 

 here lies the abiding value of Professor Crile's work. 

 His conception is that general anaesthetics, whilst 

 they protect the cerebral cortex from painful impulses, 

 do not afford much protection to the lower level 

 centres in the brain-stem. Inasmuch as the cutting, 

 crushing, dragging, burning, or other injuries inflicted 

 on the limbs or viscera cannot be spoken of as painful 

 when owing to the ether or chloroform no pain is 

 felt, these are described as " nociceptive " impulses 

 (Sherrington). Crile's method is to prevent the 

 origin or block the path of the nociceptive impulses 

 by means of local anaesthetics, principally novocain 

 for the skin, nerve-trunks, and subcutaneous tissues, 

 and quinine-urea-hydrochloride for the peritoneum. 

 Although the patient is under a general anaesthetic, 

 the line of skin incision is injected with novocain. 

 In an amputation, the main nerves are blocked with 

 the same drug. All suture lines and cut edges of 

 the peritoneum are mopped with the quinine-urea- 

 HCl solution (0-5 per cent of each) before and 

 afterwards. Intraspinal anaesthesia is of course an 

 extension of the method. 



Further, all manipulations must be conducted 

 with the most extreme gentleness. Crile protests 

 very strongly against what he calls " carnivorous " 

 surgery. And, thirdly, he finds that nitrous-oxide- 

 oxygen produces much less chromatolysis of nerve- 

 cells than ether or chloroform, and therefore uses 

 it for nearly all operations. 



The results, though not yet perfect, are most 

 promising. Shock is greatly diminished, painful 



