the origin and nature of emotions-第7章

按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！


id　causes　an　increased　secretion。　　The　origin　of　many　cases　of　Graves'　disease　is　closely　associated　with　some　of　the　causes　of　the　discharge　of　nervous　energy；　depressive　influences　especially；　such　as　nervous　shocks；　worry　and　nervous　strain；　disappointment　in　love；　business　reverses；　illness　and　death　of　relatives　and　friends。　The　association　of　thyroid　activity　with　procreation　is　well　known；　hence　the　coincidence　of　a　strain　of　overwork　or　of　fear　with　the　sexual　development　of　maturing　girls　is　obviously　favorable　to　the　incidence　of　Graves'　disease。　　The　presence　of　a　colloid　goiter　is　a　suitable　soil　for　the　development　of　Graves'　disease；　and　I　fully　recognize　also　the　evidence　that　infection　or　auto…intoxication　may　be　contributing　factors　and　must　be　assigned　their　role。

I　have　never　known　a　case　of　Graves'　disease　to　be　caused　by　success　or　happiness　alone；　or　by　hard　physical　labor　unattended　by　psychic　strain；　or　to　be　the　result　of　energy　voluntarily　discharged。　Some　cases　seem　to　have　had　their　origin　in　overdosage　with　thyroid　extract　in　too　vigorous　an　attempt　to　cure　a　colloid　goiter。　One　of　the　most　striking　characteristics　of　Graves'　disease　is　the　patient's　loss　of　control　and　his　increased　susceptibility　to　stimuli；　especially　to　trauma　and　to　fear　and　to　the　administration　of　thyroid　extract。　　It　has　been　shown　that　the　various　causes　of　the　discharge　of　nervous　energy　produce　alterations　in　the　nervous　system　and　probably　in　the　thyroid　gland。　　This　is　especially　true　of　the　fear　stimulus；　and　has　been　clearly　demonstrated　in　the　brains　of　rabbits　which　had　been　subjected　to　fear　alone　（Fig。　13）。　Of　special　interest　was　the　effect　of　daily　fright。　In　this　case　the　brain…cells　showed　a　distinct　change；　although　the　animal　had　been　subjected　to　no　fear　for　twenty…four　hours　before　it　was　killed　（Fig。　13　C。　Now；　a　great　distinction　between　man　and　the　lower　animals　is　the　greater　control　man　has　acquired　over　his　actions。　This　quality　of　control；　having　been　phylogenetically　most　recently　acquired；　is　the　most　vulnerable　to　various　NOCUOUS　influences。　The　result　of　a　constant　noci…integration　may　be　a　wearing…out　of　the　control　cells　of　the　brain。　　In　a　typical　case　of　Graves'　disease　a　marked　morphologic　change　in　the　brain…cells　has　been　demonstrated　（Fig。　15）。　As　has　been　previously　stated；　the　origin　of　many　cases　of　Graves'　disease　is　associated　with　some　noci…influence。　If　this　influence　causes　stimulation　of　both　the　brain　and　the　thyroid；　its　excessive　action　may　cause　impairment　of　the　brain　and　also　hyperplasia　of　the　thyroid。　As　self…control　is　impaired；　fear　obtains　an　ascendency　and；　_pari　passu_；　stimulates　the　thyroid　still　more　actively　（Fig。　16）。　Finally；　the　fear　of　the　disease　itself　becomes　a　noci…stimulus。　As　the　thyroid　secretion　causes　an　increase　in　the　facility　with　which　nervous　energy　is　discharged；　a　pathologic　reciprocal　interaction　is　established　between　the　brain　and　the　thyroid。　The　effect　of　the　constantly　recurring　stimulus　of　the　noci…influence　is　heightened　by　summation。　　This　reciprocal　goading　may　continue　until　either　the　brain　or　the　thyroid　is　destroyed。　If　the　original　noci…stimulus　is　withdrawn　before　the　fear　of　the　disease　becomes　too　strong；　and　before　too　much　injury　to　the　brain　and　the　thyroid　has　been　inflicted；　a　spontaneous　cure　may　result。　Recovery　may　be　greatly　facilitated　by　complete　therapeutic　rest。　A　cure　implies　the　return　of　the　brain…cells　to　their　normal　state；　with　the　reestablishment　of　the　normal　self…control　and　the　restoration　of　the　thyroid　to　its　normal　state；　when　the　impulses　of　daily　life　will　once　more　have　possession　of　the　final　common　path　and　the　noci…influence　will　be　dispossessed。　The　discovery　of　the　real　cause　of　a　given　case　of　Graves'　disease　is　frequently　difficult　because　it　may　be　of　a　painful　personal　nature。　Of　extreme　interest　is　the　fact　that；　in　the　acute　stage；　the　patient　may　be　unable　to　refer　to　the　exciting　cause　without　exhibiting　an　exacerbation　of　the　symptoms　of　the　disease。　I　presume　no　case　should　be　regarded　as　cured　until　reference　can　be　made　to　its　cause　without　an　abnormal　reaction。　It　has　been　established　that　in　Graves'　disease　injury　to　any　part　of　the　body；　even　under　inhalation　anesthesia；　causes　an　exacerbation　of　the　disease。　　Fear　alone　may　cause　an　acute　exacerbation。　These　acute　exacerbations　are　frequently　designated　〃hyperthyroidism〃　and　are　the　special　hazard　of　operation。

In　applying　the　principle　of　anoci…association　in　operations　on　patients　with　Graves'　disease　there　is　scarcely　a　change　in　the　pulse；　in　the　respiration；　or　in　the　nervous　state　at　the　close　of　the　operation。　I　know　no　remedy　which　can　obviate　the　effect　of　the　inflowing　stimuli　from　the　wound　after　the　cocain＇*＇　has　worn　off。＇t＇　It　is　necessary；　therefore；


Beats　70　80　90　100　110　120



Ether　*******　********　********　********　********



N2O　*******　********　********　********　*



Anoci。　　*******　********　********　**　not　to　venture　too　far　in　serious　cases。　　Since　the　adoption　of　this　new　method　（anoci…association）　my　operative　results　have　been　so　vastly　improved　that　I　now　rarely　regard　any　case　of　Graves'　disease　as　inoperable；　at　least　to　the　extent　of　contraindicating　a　double　ligation　（Fig。　17）。


＇*＇　See　footnote；　page　4。@@@

＇t＇　In　later　papers　and　in　〃Anoci…association〃　（Crile　and　Lower）　methods　of　combating　postoperative　hyperthyroidism　are　fully　discussed。


If　we　believe　that；　in　accordance　with　the　law　of　phylogenetic　association；　a　continuous　stimulation　of　both　the　brain　and　the　thyroid　gland；　accelerated　by　summation；　plays　a　role　in　the　establishment　of　the　pathologic　interaction　seen　in　Graves'　disease；　then　it　is　but　the　next　step　to　assume　that　if　the　nerve　connection　between　the　brain　and　the　thyroid　be　severed；　or　if　the　lobe　be　excised　and　the　patient　reinforced　by　a　sojourn　in　a　sanatorium　or　in　some　environment　free　from　former　noci…associations；　he　may　be　restored　to　normal　health；　provided　that　the　brain…cells；　the　heart；　or　other　essential　organs　have　not　suffered　irreparable　damage。　There　are　still　many　missing　links　in　the　solution　of　this　problem；　and　the　foregoing　hypotheses　are　not　offered　as　final；　although　from　the　viewpoint　of　the　surgeon　many　of　the　phenomena　of　this　disease　are　explicable。


Sexual…Neurasthenia


The　state　of　sexual　neurasthenia　is　in　many　respects　analogous　to　that　of　Graves'　disease。　　In　the　sexual　reflexes；　summation　leads　to　a　hyperexcitability　by　psychic　and　mechanical　stimuli　of　a　specific　type　which　is　analogous　to　the　hyperexcitability　in　Graves'　disease　under　trauma　and　fear；　the　explanation　of　both　conditions　is　based　on　the　laws　of　the　discharge　of　energy　by　phylogenetic　association　and　summation。　　It　would　be　interesting　to　observe　the　effect　of　interrupting　the　nerve　impulses　from　the　field　of　the　sexual　receptors　by　injections　of　alcohol；　or　by　other　agencies；　so　as　to　exclude　the　associational　stimuli　until　the　nervous　mechanism　has　again　become　restored　to　its　normal　condition。　Interpretation　of　Some　of　the　Phenomena　of　Certain　Diseases　of　the　Abdomen　in　Accordance　with　the　Hypothesis　of　Phylogenetic　Association


The　law　of　phylogenetic　association　seems　to　explain　many　of　the　phenomena　of　certain　lesions　in　the　abdominal　cavity。　The　nociceptors　in　the　abdomen；　like　nociceptors　elsewhere；　have　been　established　as　a　result　of　some　kind　of　injury　to　which　during　vast　periods　of　time　this　region　has　been　frequently　exposed。　On　this　premise；　we　should　at　once　conclude　that　there　are　no　nociceptors　for　heat　within　the　abdomen　because；　during　countless　years；　the　intra…abdominal　region　never　came　into　contact　with　heat。　That　this　inference　is　correct　is　shown　by　the　fact　that　the　application　of　a　thermocautery　to　the　intestines　when　completing　a　colostomy　in　a　conscious　patient　is　absolutely　painless。　One　would　conclude　also　that　there　are　no　touch　receptors　in　the　abdominal　viscera；　and　therefore　no　sense　of　touch　in　the　peritoneum。　Just　as　the　larynx；　the　ear；　the　nose；　the　sole　of　the　foot；　and　the　skin　have　all　developed　the　specific　type　of　nociceptors　which　are　adapted　for　their　specific　protective　purposes；　and　w