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hepatic vein also。
In fact； the H…ion concentration of the blood in the adrenal vein was less than in the blood of any other part of the circulation。
Kinetic Diseases
If our conclusions are sound； then in the kinetic system we find an explanation of many diseases； and having found the explanation； we may find new methods of combating them。
When the kinetic system is driven at an overwhelming rate of speed； as by severe physical injury； by intense emotional excitation； by perforation of the intestines； by the pointing of an abscess into new territory； by the sudden onset of an infectious disease； by an overdose of strychnin； by a Marathon race； by a grilling fight； by foreign proteins； by anaphylaxis；the result of these acute overwhelming activations of the kinetic system is clinically designated shock； and according to the cause is called traumatic shock； toxic shock； anaphylactic shock； drug shock； etc。
The essential pathology of shock is identical whatever the cause。 If； however； instead of an intense overwhelming activation； the kinetic system is continuously or intermittently overstimulated through a considerable period of time； as long as each of the links in the kinetic chain takes the strain equally the result will be excessive energy conversion； excessive work done； but usually； under stress； some one link in the chain is unable to take the strain and then the evenly balanced work of the several organs of the kinetic system is disturbed。 If the brain cannot endure the strain； then neurasthenia； nerve exhaustion； or even insanity follows。 If the thyroid cannot endure the strain； it undergoes hyperplasia； which in turn may result in a colloid goiter or in exophthalmic goiter。 If the adrenals cannot endure the strain； cardiovascular disease may develop。 If the liver cannot take the strain； then death from acute acidosis may follow； or if the neutralizing effect of the liver is only partially lost； then the acidity may cause Bright's disease。 Overactivation of the kinetic system may cause glycosuria and diabetes。
Identical physical and functional changes in the organs of the kinetic system may result from intense continued stimulation from any of the following causes： Excessive physical labor； athletic exercise； worry or anxiety； intestinal autointoxication； chronic infections； such as oral sepsis； tonsillitis； and adenoids； chronic appendicitis； chronic cholecystitis； colitis； and skin infections； the excessive intake of protein food （foreign protein reaction）； emotional strain； pregnancy； stress of business or professional life all of which are known to be activators of the kinetic system。
From the foregoing statements we are able to understand the muscular weakness following fever； we can understand why the senile have neither muscular power nor strong febrile reaction； why long…continued infections produce pathologic changes in the organs constituting the kinetic chain； why the same pathologic changes result from various forms of activation of the kinetic system。 In this hypothesis we find a reason why cardiovascular disease may be caused by chronic infection； by auto…intoxication； by overwork； or by emotional excitation。 We now see that the reason why we find so much difficulty in differentiating the numerous acute infections from each other is because they play upon the same kinetic chain。 Our postulate harmonizes the pathologic democracy of the kinetic organs； for it explains not only why； in many diseases； the pathologic changes in these organs are identical； but why the same changes are seen as the result of emotional strain and overwork。 We can thus understand how either emotional strain or acute or chronic infection may cause either exophthalmic goiter or cardiovascular disease； how chronic intestinal stasis with the resultant absorption of toxins may cause cardiovascular disease； neurasthenia； or goiter。 Here is found an explanation of the phenomena of shock； whether the shock be the result of toxins； of infection； of foreign proteins； of anaphylaxis； of psychic stimuli； or of a surgical operation with its combination of both psychic and traumatic elements。
This conception of the kinetic system has stood a crucial test by making possible the shockless operation。 It has offered a plausible explanation of the cause and the treatment of Graves' disease。 Will the kinetic theory stand also the clinical test of controlling that protean disease bred in the midst of the stress of our present…day life？ Present…day life； in which one must ever have one hand on the sword and the other on the throttle； is a constant stimulus of the kinetic system。 The force of these kinetic stimuli may be lessened at the cerebral link by intelligent controla protective control is empirically attained by many of the most successful men。 The force of the kinetic stimuli may be broken at the thyroid link by dividing the nerve supply； reducing the blood supply； or by partial excision； or if the adrenals feel the strain； the stimulating force may be broken by dividing their nerve supply； reducing the blood supply； or by partial excision。 No theory is worth more than its yield in practice； but already we have the shockless operation； the surgical treatment of Graves' disease； and the control of shock and of the acute infections by overwhelming morphinization （Figs。 62； 72； and 73）。
Conclusions
To become adapted to their environment animals are transformers of energy。 This adaptation to environment is made by means of a system of organs evolved for the purpose of converting potential energy into heat and motion。 The principal organs and tissues of this system are the brain； the adrenals； the thyroid； the muscles； and the liver。 Each is a vital link； each plays its particular role； and one cannot compensate for the other。 A change in any link of the kinetic chain modifies proportionately the entire kinetic system which is no stronger than its weakest link。
In this conception we find a possible explanation of many diseases one which may point the way to new and more effective therapeutic measures than those now at our command。
ALKALESCENCE； ACIDITY； ANESTHESIAA THEORY OF ANESTHESIA＇*＇
＇*＇ Paper delivered before the Virginia Medical Association； Washington； D。 C。； October 29； 1914。
Alkalis and bases compose the greater part of the food of man and animals； the blood in both man and animals under normal conditions being slightly alkaline or rather potentially alkaline； that is； although in circulating blood the concentration of the OH…ions upon which the degree of alkalinity dependsis but little more than in distilled water； yet blood has the power of neutralizing a considerable amount of acid （Starling； Wells）。 At the time of death； whatever its cause； the concentration of H…ions in the blood increases； the concentration of H…ions being a measure of acidity；that is； the potential or actual alkalinity decreases and the blood becomes actually neutral or acid。
To determine what conditions tend to diminish the normal alkalinity of the blood； many observations were made for me in my laboratory by Dr。 M。 L。 Menten to determine by electric measurements the H…ion concentration of the blood under certain pathologic and physiologic conditions。
As a result of these researches we are able to state that the H…ion concentration of the bloodits acidityis increased by excessive muscular activity； excessive emotional excitation； surgical shock； in the late stages of infection； by asphyxia； by strychnin convulsions； by inhalation anesthetics； after excision of the pancreas； and in the late stages of life after excision of the liver and excision of the adrenals。 Morphin and decapitation cause no change in the H…ion concentration。 Ether； nitrous oxid； and alcohol produce an increased acidity of the blood which is proportional to the depth of anesthesia。
Many of the cases studied were near death； as would be expected； since it is well known that a certain degree of acidity is incompatible with life。
Since alkalis and bases preponderate in ingested food； since alkalinity of the blood is diminished by bodily activity； and since at the point of death the blood is always acid； we may infer that some mechanism or mechanisms of the body were evolved for the purpose of changing bases into acids that thus energy might be liberated。
These observations lead naturally to the question； May not acidity of itself be the actual final cause of death？ We believe that it may be so from the facts that（1） The intravenous injection of certain acids causes death quickly； but that convulsions do not occur； since the voluntary muscles lose their power of contraction； and （2） the intravenous injection of acids causes extensive histologic changes in the brain； the adrenals； and the liver which resemble the changes invariably caused by activation of the kinetic system （Figs。 74 and 75）。 In view of these facts may we not find that anesthesia and many instances of unconsciousness are merely phenomena of acidity？
As has been stated already； we have found that the H…ion concentration of the bloodits acidityis increased by alcohol； by ether； and by nitrous oxid。 In addition our tests have shown that under ether the increase of the H…