La maladie post-operatoire: Is there order in variety? The six stimulus-response sequences

The search for a unifying concept in all post-traumatic metabolism, symbolized by the phrase "la maladie post-operatoire" has been a fruitful one, not so much because of success, as through its very failure. There is such variety in convalescent patterns that it has made it essential for students of this subject to look more closely at the nature of the stimulus response patterns and bring sharply into focus those recurring phenomena whose mixture together determines the final clinical result. In this brief introductory paper six groups of stimulus-response patterns have been identified and analyzed. The clinician needs an understanding of these patterns in everything that he does for the patient, both within the operating room and on the ward. The student of surgery must make an effort to differentiate amongst the six stimulus-response patterns. If he fails to do so he will be analyzing all surgical recovery as falling under a single sequence, an error that has been all too frequent in the literature. There may be other stimulus response patterns of greater importance which will be added to the list presented here, as research in the coming decades increases our understanding of convalescent biology. This presentation will serve as an introduction to the other papers gathered in this symposium by Dr. Clowes, all of which cast further important light on the details of the stimulus and response in surgical metabolism.