and local anesthesia.

We have now presented in summary much of the mass of experimental
and clinical evidence we have accumulated in support of our
principal theme, which is that the discharge of nervous energy is
accomplished in accordance with the law of phylogenetic association.
If this point seems to have been emphasized unduly, it is because
we expect to rear upon this foundation a clinical structure.
How does this hypothesis apply to surgical operations?


Prevention of Shock by the Application of the Principle of
Anoci-association



Upon this hypothesis a new principle in operative surgery is founded, _i.
e_., operation during the state of _anoci-association_. Assuming that
no unfavorable effect is produced by the anesthetic and that there is
no hemorrhage, the cells of the brain cannot be exhausted in the course
of a surgical operation except by fear or by trauma, or by both.
Fear may be excluded by narcotics and special management until
the patient is rendered unconscious by inhalation anesthesia.
Then if, in addition to inhalation anesthesia, the nerve-paths
between the brain and the field of operation are blocked with
cocain,[*] the patient will be placed in the beneficent state of
_anoci-association_, and at the completion of the operation will be
as free from shock as at the beginning. In so-called "fair risks"
such precautions may not be necessary, but in cases handicapped
by infections, by anemia, by previous shock, and by Graves'