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April 3, 1954


Author Affiliations

Rochester, N. Y.

JAMA. 1954;154(14):1177-1179. doi:10.1001/jama.1954.02940480029008a

Therapy may lag considerably behind the academic confirmation of the necessity for change, since established custom so often impedes progress. This clinical fallibility explains the recent well-intended but misdirected attempts of a dental colleague of mine to correct the state of vasomotor collapse after a procaine reaction. The dentist made earnest efforts to force the patient to assume the head-between-the-knees position even though the danger of the aspiration of foreign bodies was not present and although the dental chair offers an ideal opportunity to permit the rapid assumption of a supine or Trendelenburg position.

The present misguided stress on abdominal binders, sympathomimetic drugs, and the head-between-the-knees position is due to underestimation of the role of the lower extremities in the production of vasodepressor syncope. Our attempts to interpret man's behavior in the light of animal experimentation is largely to blame for this situation, for in animals postural pooling of blood

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