of the
Miscellaneous Papers
IN response to numerous requests I have brought together into this volumeeight papers which may serve as a supplement to the volumes previouslypublished[*] and as a preface to monographs now in preparation.
[*] Surgical Shock, 1899; Surgery of the Respiratory System, 1899;Problems Relating to Surgical Operations, 1901; Blood Pressurein Surgery, 1903; Hemorrhage and Transfusion, 1909;Anemia and Resuscitation, 1914; and Anoci-association, 1914(with Dr. W. E. Lower).
In the first of these addresses, the Ether Day Address, delivered atthe Massachusetts General Hospital in October, 1910, I firstenunciated the Kinetic Theory of Shock, the key to which was foundin laboratory researches and in a study of Darwin's "Expressionof the Emotions in Man and in Animals," whereby the phylogeneticorigin of the emotions was made manifest and the pathologicidentity of surgical and emotional shock was established.Since 1910 my associates and I have continued our researches through—(a) Histologic studies of all the organs and tissues of the body;(b) Estimation of the H-ion concentration of the blood in the emotionsof anger and fear and after the application of many other forms of stimuli;(c) Functional tests of the adrenals, and (d) Clinical observations.
It would seem that if the striking changes produced by fearand anger and by physical trauma in the master organ of the body—the brain—were due to WORK, then we should expect to findcorresponding histologic changes in other organs of the body as well.We therefore examined every organ and tissue of the bodies of animalswhich had been subjected to intense fear and anger and to infection andto the action of foreign proteins, some animals being killed immediately;some several hours after the immediate effects of the stimuli had passed;some after seances of strong emotion had been repeated severaltimes during a week or longer.
The examination of all the tissues and organs of these animalsshowed changes in three organs only, and with few exceptions in allthree of these organs—the brain, the adrenals, and the liver.The extent of these changes is well shown by the photomicrographswhich illustrate the paper on "The Kinetic System" which is includedin this volume. This paper describes many experiments which showthat the brain, the adrenal, and the liver play together constantlyand that no one of these organs—as far at least as is indicatedby the histologic studies—can act without the co-operationof the other two.
Another striking fact which has been experimentally establishedis that the deterioration of these three organs caused by emotion,by exertion, and by other causes is largely counteracted,if not exclusively, during sleep. If animals exhausted by the continuedapplication of a stimulus are allowed complete rest for a certainnumber of hours, *without sleep, the characteristic histologicappearance of exhaustion in the brain, adrenals, and liver is notaltered notably, whereas in animals allowed to sleep for the samenumber of hours the histologic changes in these organs are lessened—in some cases obliterated even.
This significant phenomenon and its relation will be dealt with ina