this animal no well-marked phenomena, but doses somewhat larger produce excite

ment.

Look at these two subjects: One had received 50 centigrams (grs. 7 1-2) and the other one Gram (grs. 15) of morphine hydrochloride hypodermically. These animals are excited, their eyes are bright, their ears erect; they move about constantly, either turning about where they are or pushing against the wall; they paw with their feet and neigh. Their walk is stiff, the joints hardly flexing. The general sensibility is intact and they react readily when they, are pricked in any sensitive region.

These experiments prove that the action. of morphine on the brain varies considerably with the kind of animal; but that is not all, the action on the same animal species varies also according to the size of the dose administered. The effects of small, medium or large doses are best studied on human beings, who can inform us of the subjective feelings which they experience.

In man, small doses of morphine produce a certain sense of comfort and remove all disagreeable sensations. This altogether subjective effect eludes all experimental control.

This explains the use of opium by Orientals, who expect from it intoxication, pleasant dreams and phantasmagoria. The morphinomaniac after an hypodermic injection of morphine experiences a sensation of comfort, because of the disappearance of all sensations, agreeable and disagreeable, normal and abnormal, such as those of cold and heat, and hunger and fatigue.

Is this sensation of well-being present in our animals also? Probably yes. The dog and the cat have hallucinations, and the cat rolls and plays with its paws, and seems to pursue an imaginary mouse. It is possible that this sensation of comfort exists in the horse too and this seems to result from what certain clinicians have told us, that vicious and nervous horses are often calmed after an injection of a small dose of morphine. But I hasten to remark that this is not the general rule, for most bad horses become more excited after a morphine injection.

Medium doses of morphine influence first of all the functions of the cerebral cortex and act more expecially on the sensitive centers. It suppresses in man all slight pains, but the severe pains, such for instance as those caused by cutting instruments or by very painful inflammations, are perceived yet.

Seeing, hearing, and association of images (ideas) are intact.

The principal phenomenon which we observe here is the suppression of slight pain, and for this reason morphine is used in all cases where insomnia is caused by excitement and suffering. Morphine, in medium doses, does not put a man to sleep but it quiets his pain which keeps him awake and sleep comes about indirectly. Morphine procures euphoria hence its use in cancer, tuberculosis, etc.

Does a medium dose of morphine act on animals in the same way, i. e., by suppressing pain and procuring euphoria? It may be difficult to answer this question, because it concerns a subjective sensation, and an animal generally does not manifest a feeling of pain before it becomes very vivid, yet judging from what we observe in animals under great pain, we are induced to say that morphine does calm pain in the dog but does not do so in the horse, nor in bovines, nor in the cat.

Lastly, morphine in large doses produces profound sleep in man and sensibility is apparently totally abolished.

In our domestic animals the reaction is altogether different. The dog reacts to morphine nearly like

man.

He falls asleep, but the sleep is less profound; he awakes at times, barks and falls asleep again; his sensibility is quite dulled and he frequently lets himself be operated upon without manifesting any pain.

In the horse we observe nothing of this kind. This animal never sleeps under the influence of morphine and remains always sensitive to a prick and a cut of the knife, and often the morphine seems to augment the sensibility, as in the case I show you here:

We have injected morphine experimentally in twenty horses, and all of them have

reacted like normal animals, and at times quite decidedly. We believe, therefore, that we are entitled to say that morphine is not a central analgesic for the horse, whose vivid pains it does not calm.

Recapitulating we say: Morphine exercises in all animals a specific action on the brain. In some it produces sleep, while in others, on the contrary, it produces excitement and a kind of inebriation, and in all it seems to produce a feeling of well-being and causes the disappearance of disagreeable sensations.

Morphine is not, however, a central anesthetic in the same sense as chloroform. In the animals which it puts to sleep, it dulls profoundly the sensibility to point that they are very frequently able to endure the acute pain caused by the surgeon's knife, while in the animals which morphine does not put to sleep it does not suppress the perception of pain.

HALLUCINATION AND DECEPTION AS

ILLUSTRATED IN MOHAMMED

Referring to the miracles which are reported of Mohammed, Obbink makes the following interesting statement, which may throw considerable light upon the mental processes of the prophet.

Even admitting that such and such a miracle as is attributed to him was actually reported by himself as having taken place, is it then right to speak of "intentional deception"?

We have here to consider his personal peculiarities. It is beyond doubt that he showed symptoms of a very irritable nervous system and that he suffered from hallucinations. Hallucinations are delusions of the senses which are traceable to the brain, and the idea that they are founded on realities is, according to scientific results, hardly tenable. When it is established that the subject-matter of the Prophet's hallucination, when the spell was over, was regarded by him as having actually transpired, then we have, by it, the possibility to be just in judging of Mohammed's inspiration, whether it be real or supposed.

L. Krehl has proved that hallucinations are actual sensations and not imaginary ones. The patient sees, hears, and smells actually and does not merely believe he hears, sees and smells. If we desire to dispute the varying of the subject's senses with him, we then receive from him the same answer which Lauret received from one of his patients:

"I hear voices because I hear them; how they come about I know not, but they are to me as definite as is your own voice to me."

It is clear that under just such conditions the representations and things which are connected with his state for the time being force themselves upon the patient, so that the contents of his hallucinations come pure from his heart and permit us to have a look into his heart, while his acts and words in his normal state permit us to do so but approximately, only because of the many hindering circumstances (selfconstraint, etc.) standing in the way of perfectly free expression. Hence it is possible also that Mohammed did not become personally better and holier by his inspirations.

As an honest enthusiast he may have been perfectly persuaded that God spoke through him, but he received only just the revelations of which he was in need. His revelations were only the echo of his own soul although, notice! he himself saw in it a real divine communication. This view of the matter must be constantly borne in mind.

We therefore should not berate him as a deceiver although he did many things which gave occasion to rate him thus. Neither should we condemn him as a sensualist, although he committed many an immoral act, and we should not excuse vice by disease. Nor should we lay the name of "false prophet" to his charge, although he founded a religion which thoroughly antagonizes Christianity.

Mohammed was better than his religion, better because he knew not himself how mentally sick he was. He thought he was a prophet, while he was a pseudo prophet.— Glauben und Wissen, August, 1904, pp. 269-270.

IT

T may be conceded that there is an average of human nature in the medical profession, and, like other people, physicians are prone to dwell on their successes rather than on the failures. I have thought, however, that we might derive a measure of mutual benefit by discussing at times some of our failures, and to this end I ask your indulgence for a little while, that I may submit for your consideration and criticism a brief report of a few clinical failures in my practice.

Shortly after I commenced the practice of medicine I was called, one day, to see a negro boy about six years old and found him suffering from pain in the abdomen. Considering the age of the patient, I naturally surmised that I had a case of plain bellyache, but upon making some investigations, I began to have some doubt about that. There was some tenderness but no tympany, and I found that palpation was painful, which I had been taught was characteristic of inflammatory conditions, whereas pressure is grateful in colic. I inquired carefully as to what the boy had been eating, and also, asked if he had been hurt in any way, but elicited no suggestive information.

I gave him an enema, had a turpentine stupe placed on the abdomen, and gave him some Dover's powder, with instructions to renew the stupe and repeat the anodyne if necessary, and to give a good dose of epsom salt next morning. The following day I found the patient much relieved; the bowels had moved well and there was

*Read before the Clarendon County Medical Association, March 29, 1911.

less tenderness under palpation. I thereupon renewed my instructions and dismissed the case conditionally.

Three or four days later I was sent for again, with a statement that the boy was worse. When I reached the bedside I found him suffering intensely with what appeared to be diffuse peritonitis. Exactly what treatment I resorted to I do not recall now, but I failed to relieve the patient, for two days later he died. I said that he died from peritonitis, but the father recalled my inquiry at the first visit as to whether the boy had been hurt in any way, and he also recalled that the boy had reported two or three weeks before that he had been kicked "in the stomach" by another boy nearly grown and was ordered away from a butcher pen where he was loitering.

The father thereupon called upon the coroner and requested an investigation. An inquest was held, and the jury, after hearing my statement, ordered an autopsy. I asked a young medical friend to go with me and we made a careful examination of the body. There were no external signs of violence, and when I opened the abdominal cavity we could find no indication of bruise or contusion, but we did find the vermiform appendix completely necrosed and in a granular condition. There was no pus. I reported to the jury that there were no indications of violence and that death was apparently due to natural causes, and they formulated a verdict to that effect.

Remember that appendicitis had not at that time become a popular or fashionable affliction, and I was not looking for

anything by that name when I was treating the boy. I did not learn until several years later that external violence was recognized as one of the causes of appendicitis, and then I began to doubt the correctness of my professional report to that jury of inquest, although at the time I was complimented by a good old physician upon the excellent frame-up of that report.

About ten or twelve years ago I was called to go several miles in the country to see a sick baby in a family I did not know, and on a plantation that was somewhat out of my regular beat. When I got to the house I found an infant some two or three months old greatly disfigured with blebs, from the size of a pea to that of a hen's egg, distributed about the face, head and ears and on the hands and forearms. There was no pyrexia, no disturbance of the bowels, and the infant was contentedly nursing an apparently healthy mother.

I was informed that the blisters had appeared during the day and night before. I had a vague recollection of having read about some such skin affection, probably having heard it described in didactic lectures, but had never seen the condition clinically. I did not call the thing by any name then, but proceeded to evacuate the blebs of their watery contents, dusted the surface with a bland powder and applied cotton and bandages, so arranging the latter as to prevent the child from injuring itself by scratching. I learned afterward that I probably had a case of acute pemphigus vulgaris, a rare disease in this country, and one that occurs, as a rule, only in children and usually runs a favorable course except in ill-nourished ones. (Stelwagon.) This child was in a well-nourished condition.

When I had finished the dressing, the old man of the house, grandfather of the patient, said, "Doctor, here is another patient for you over here on the bed." I turned my attention in that direction and found a little girl of about six years, with considerable fever, headache, a browncoated tongue, no appetite, and constipated. With no history of exposure and no special pathognomonic features, I judged this to be a case of autointoxication, possibly due

to errors of diet. I put her on treatment to relieve the fever and headache and to clean out the intestinal tract. I did not make an appointment to return, but told the people to let me know if the children did not get along satisfactorily. That was on Tuesday, and as I did not get any further report, I supposed the patients were progressing favorably. I don't know whether I did not feel some degree of satisfaction at having handled the cases so nicely.

The next Saturday I met a man who happened to know of my treating the children. He stopped and asked, "Doctor, what was the matter with those children over on Jones's place?" In a rather noncommittal manner I told him that they were affected very differently, and in turn asked him how they were getting along. "Why," he said, "they both died the next day after you saw them."

From that day on to this I have never been able to figure out to my own satisfaction what caused the death of those two children. Possibly the outcome of the cases had something to do with the fact that I never had another call to the Jones place. I never heard any expression of dissatisfaction from the family, nor did I ever receive my compensation for my visit.

Manning, S. C.

A. S. TODD.

DESPERATE GUNSHOT WOUND OF THE ARM

On the evening of December 29, 1899, I was called to see a boy of 16 who had been shot in the right arm, the charge tearing away the greater part of the biceps, breaking the humerus at about the middle, and shattering the deltoid into fragments. The bone was broken, not, however, by direct action of the shot, but by the force of the explosion. There were no shot marks on the bone, but it was stripped of periosteum for about an inch on each side of the fracture, but the tissues were full of shot. The clothing had taken fire and the wound and adjacent skin had been badly scorched. The wound was eight

inches in length, not counting the injury to the biceps.

Contrary to the advice of my assistant, I decided to attempt saving the arm. The plan I followed was to cut off the denuded bone, drill holes through the ends and tie them together, and put on splints to immobilize the member and trust to nature and

from time to time, including iodoform, aristol, boric acid, and so on. The cutting away of the two inches of bone did more for us than the removing of what would cause a failure by reason of the presence of dead osseous tissue-we lessened the length of the wound from eight inches to six.

On the morning of the 45th day, photograph No. 1 was taken. The boy was just able to sit up, with me behind a screen to hold him up while the snapshot was taken.

Picture No. 2 was taken just a year, to an hour, from the day he was shot. Two years and a half after the accident the young man played a game of tenpins with me, using a 16-pound ball, and I had to bowl over 182 to beat him. He is a bricklayer and plasterer by trade, can use a

No. 1. Picture taken on the forty-fifth day after accident

good care to produce results. My reasons for being willing to make the attempt were: I knew the boy from birth and had faith in his tenacity of life to enable him to "come back," and in the further fact that the brachial artery was uninjured. With a subject less promising and the artery for supplying the arm in doubtful condition, I should not have made the attempt.

After getting all the shot out of the wound, trimming off all devitalized tissue, and stitching together all the sound strips of muscle I thought might be saved, I did up the member as indicated above. We had to dress the arm every twenty-four to forty-eight hours, and for the first six times this was done under chloroform. We used dry antiseptic dressings all the way through, but had to ring the changes,