reviewed by my assistant, Dr. R. S. Woodworth.* Dr. Woodworth shows that peripheral sensations, such as soreness, for example, are factors which naturally produce a feeling of fatigue and a consequent tendency to stop work, although in reality the nerve cells and the muscles are fully capable of continuing to act. If the narcotic effect of alcohol dulls these sensations of fatigue, work would seem easier. It is known that many sensory stimuli entering the cord rouse the motor cells to increased irritability. Thus each sound of the rhythmical beat of a drum stimulates the cord cells that they may more readily discharge. In the same way Féré claims that the sensory stimulation of merely washing the mouth with brandy enables one to do more work. One can only surmise concerning the direct effect of alcohol on the motor area of the brain or on the cord cells themselves. Concerning the action of alcohol upon the muscle substance, important results have been communicated to me by my friend, Dr. F. S. Lee of Columbia University, and I am permitted to lay them before you here. Dr. Lee finds that in the curarized frog's muscle, where all the nervous influence is removed, the immediate effect of alcohol is to increase the amount of work done even by 100%. The individual muscle contraction is quicker and fatigue is delayed. The secondary effect, that is, the result after the action of alcohol has lasted for an hour, is directly the reverse of the above, there is a depression, a decreased ability to work. If it were possible to apply these experiments to protoplasm in general and to the nerve cells in particular, we would perhaps say that the action of alcohol was first to stimulate and then to depress. It seems hardly necessary to refer to the fact that the use of alcohol in armies as a means of obtaining additional expenditure of physical force has long since been abandoned. New York University Bulletin of Medical Sciences, 1901, i, 133. After taking alcohol the sum total of work done will not be increased, but rather diminished. The depressant effect is the predominating factor in the long run. Where muscular work becomes of the minute, painstaking kind, the action of alcohol is not favorable for its accomplishment. Thus Aschaffenburg* found in the case of four typesetters that the effect of drinking 200 cc. of Greek wine containing 18% of alcohol was to reduce the speed of typesetting on an average of 15.2%, while it was noticed that the accuracy of typesetting was unaffected. von Vintschgau and Dietl† have measured the reaction time before and after drinking two-bottles of Rhine wine. The reaction time was much delayed, although the persons thought that they were acting quicker than before. Concerning the action of alcohol on intellectual activity, Smith has shown that 40 to 80 gm. of alcohol will depress the mental power, as indicated by the ability to memorize or to calculate, and it especially depresses the power to improve by practice. Fürer says that a mild intoxication results in intellectual depression lasting for twenty-four hours or more. Without doubt alcohol reduces the power to do both physical and mental work. It reduces the power to learn. All the mental work done in the above experiments was of the minute, painstaking sort. Dr. Woodworth has suggested to me that intellectual activity with some swing and freedom about it and aiming only at broad effects might be differently influenced, as seems indeed to be the case with some orators, musicians, and possibly writers. On the whole, the moderate use of alcohol as a beverage gives additional flavor to the food, and acts as a mild narcotic, often preceded by a period of exhilaration. * Kræpelin's Psychologische Arbeiten, 1896, i. 608. Archiv. f. Psych., 1895, Bd. xxvii, p. 970. ARTICLES XV.-XIX. HEAD INJURIES. NON-OPERATIVE HEAD INJURIES. OF TAUNTON. INDICATIONS FOR OPERATION IN HEAD INJURIES. BY EDWIN W. DWIGHT, M.D. OF BOSTON. INDICATIONS FOR OPERATION ON HEAD INJURIES. BY WILLIAM N. BULLARD, M.D. OF BOSTON. GUNSHOT WOUNDS OF THE HEAD AND CRANIUM. BY LOUIS A. LAGARDE, MAJOR AND SURGEON U. S. ARMY. TECHNIQUE AND AFTER-CARE OF OPERATIONS UPON THE CRANIUM. BY CHARLES L. SCUDDER, M.D. OF BOSTON. READ JUNE 10, 1902. ARTICLE XV. NON-OPERATIVE HEAD INJURIES. BY THOMAS J. ROBINSON, M.D., OF TAUNTON. FIRST, just what is meant by non-operative? The term as used here simply means injuries in which no operation on the skull or its contents is advisable. These cases include injuries to the scalp; certain injuries to the skull; certain injuries to the brain; very often a combination of all three. Classified, they come under the following heads: Injuries to the scalp; certain forms of vertex fractures; fractures of the base; cerebral concussion and contusion; certain cases of compression; certain cases of laceration. INJURIES TO THE SCALP. The only question of diagnosis in contusion of the scalp is in reference to fractures. Effusion of blood beneath the aponeurosis may often be extensive, and sometimes the margin of the effusion may have such a raised, hard feel that it is difficult to rule out a depressed fracture. Here, when the diagnosis is doubtful, it is best to make an open incision. These injuries are treated simply by cold applications and a suitable compression bandage. If there is a large hematoma which absorbs very slowly time will be saved by making an incision and turning out the clot. The diagnosis of scalp wounds is of course obvious. Here in addition to the general canons of wound treatment |