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Observations on Patients whose Associational Centers are Dulled, and on Diseases and Injuries of Regions not Endowed with Nociceptors

Reversing the order of our reasoning, let us now glance at the patient who is unconscious and who, therefore, has lost much of the power of association. His mouth is usually

dry, the digestive processes are at a low ebb, the aroma of food causes no secretion of saliva, tickling the nose causes no sneezing; he catches no cold. The laryngeal reflex is lost and food may be quietly inhaled; the entire process of metabolism is low. The contrast between a man whose associational centers are keen and a man in whom these centers are dulled or lost is the contrast between life and death.

In accordance with the law of adaptation through natural selection, phylogeny, and association, one would expect no pain in abscess of the brain, in abscess of the liver, in pylephlebitis, in infection of the hepatic vessels, in endocarditis. This law explains why there are no nociceptors for cancer, while there are active nociceptors for the acute infections. It is because nature has no helpful response to offer against cancer, while in certain of the acute pyogenic infections the nociceptors force the beneficent physiologic rest.

Could we dispossess ourselves of the shackles of psychology, forget its confusing nomenclature, and view the human brain, as Sherrington has said, "as the organ of, and for the adaptation of nervous reaction," many clinical phenomena would appear in a clearer light.