be clear. I think the introduction of the intubation tube forced them. all out of the larynx. I then tried a second time to introduce the tube but was not successful. He is now able to breathe through the larynx for an hour or two at a time.

Dr. S. G. Dabney: It is not common for papilloma to remain beneath the vocal cords; the great majority of them are attached either to the cords or above them and can be reached through the mouth. Four or five years ago I had under my care a man who had his throat cut just below the larynx. He had entirely lost his voice. Examination showed a tumor as large as a cherry just beneath the vocal cords and in front corresponding to the wound in the skin. The man had a very excellent throat to operate upon, and after treating him for a little while I took a long pair of forceps, went below the vocal cords and bit off a piece of the tumor. It contained a thread which had caused the growth of granulation tissue. The remaining part quickly disappeared, and there has been no return.

Dr. J. B. Marvin: I will mention a case that many members of the Society have seen. The man came to my clinic complaining of some gastric trouble. I detected quite a large tumor in the median line just in the nick between the ensiform cartilage and ribs-hard, and of considerable size. He had the vessels of a man of sixty-five although he claimed to be only forty-six. He was surprised when told that he had a tumor, claiming that he had been treated for some hepatic disorder. The case was shown at the Academy of Medicine, and quite a number of you examined him. The tumor grew very rapidly. There was a history of vomiting, constipation, and absence of hydrochloric acid, all pointing to malignant disease of the stomach. Two or three weeks later I thought there was faint fluctuation. He disappeared for a month. Last week he appeared at the clinic again. The tumor had grown a good deal and there was no question of its containing fluid. He had pain and vomiting of blood. I took him before the class, and, introducing a hypodermic needle, drew off some fluid which looked like bile, but was not bile. The man consented to an exploratory incision, and Dr. Holloway operated that afternoon. He was firmly of the opinion that it was a gall-bladder, simply on account of its position. The incision was made in the median line. Putting aside the omentum and raising the stomach, he found the tumor bulged from behind the stomach. The tumor was incised and a coffee-colored fluid squirted out.

He then introduced his hand into the cavity and scraped out a large amount of thick, grayish-brown material. In the mesentery there were several cysts as large as hen eggs. The man has done admirably so far. Careful chemical and microscopical examination of this fluid proved that it was not bile, and I am of the opinion that it was a cyst, springing from the mesentery perhaps.

Dr. F. C. Wilson: About eighteen months ago I delivered a primipara after a normal labor of a child seemingly healthy and strong, weighing perhaps seven or eight pounds. About the time the cord began to separate there was hemorrhage; every effort failed to stop it, and the child finally died from loss of blood. I found that the mother was a "bleeder," and this in all probability accounted for the condition of the child. I cautioned her, if she ever became pregnant again, to undergo some treatment looking to the correction of this tendency in the child. Some time afterwards the husband informed me that she had probably conceived again. After a few months I put her on turpentine and iron and told her to keep it up all through pregnancy. She went on comfortably until about the fifth month, when they sent for me. The patient said she had not felt any movement of the child for several days; that movements had been quite active up to that time. She was probably between the sixth and seventh month. I could not. detect any sounds that were distinctive. I advised waiting, telling her that in all probability the child was dead and would be cast off in a week or two, and if alive would probably recover. She went on, and felt faint movement until about the middle of the eighth month, when the child was born dead. It had in all probability been dead for two weeks at least. It had evidently developed from the time I had first listened for the fetal heart-sounds, and no doubt was alive at that time. The point of interest in the case is, whether the administration of iron and turpentine was rational, or whether it had any thing to do with the death of the child. The dose was only four or five drops of turpentine and eight or ten drops of iron. JOHN L. HOWARD, Secretary.

12

Vol. 20.

"NEC TENUI PENNÂ.”

SATURDAY, AUGUST 24, 1895.

No. 4.

D. W. YANDELL, M. D., LL.D., and H. A. COTTELL, M. D., Editors.
JOHN L. HOWARD, M. D., Assistant Editor.

A Journal of Medicine and Surgery, published every other Saturday. Price, $3 per year, postage paid.

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MEMBRANE OF THE HEN'S EGG IN GRAFTING,

The New York Medical Journal gives a very interesting instance of the successful employment of this substance in place of skin-grafting by M. Amat. This surgeon was called to treat a large burn in a boy upon the dorsal region. Repair being very slow the surgeon suggested skin-grafting, but, as this measure was objected to by the parents of the child, the idea came to him that the internal vascular layer of the membrane of the hen's egg might answer the purpose. Accordingly the membrane was employed with satisfactory results. Since this time (some five years since) M. Amat and others have employed this method of grafting with success in numerous cases.

The technique of this operation is as follows: (1) The membrane should be taken from a very fresh egg, as physiological observation has shown that the latent life of this membrane is then more active. (2) Grafting must not be done until the dressings have suppressed the suppuration and provoked a healthy growth. Previously to the transplantation contact with the air must be avoided by a thick dressing of gauze saturated with a carbolic-acid solution. (3) Take a very fresh egg, break it in the center, empty it of the contents, and seize the membrane with a mouse-tooth forceps at the large end of the egg, that is, the internal layer of the membrane of the shell. (4). This layer is cut into strips about four or five millimeters in width and of the same length. These are applied on the wound with the point of a pair of scissors, and laid on their albuminous surface. (5) They are applied at a distance from twelve to fifteen millimeters, and are covered with a small square of tin foil and then by a dressing of gauze saturated

with a solution of carbolic acid. This heteroplastic procedure, says the writer, is worthy of attention, especially from practitioners who do not always have at hand the proper material for "inter-human" or inter-zoohuman" heteroplasty.

The good results, the author says, "may be attributed to the 'action of vacinity' of the graft on the evolution of the embryonic tissue, and not to its nature." This "action of vacinity" would seem a little obscure as an explanation of a physiological process. If the inner vascular surface of the skin of the egg has in it embryonic epithelial cells, it is easy to see how it might build up new skin upon a surface denuded by a burn, though we should think the patient would run considerable risk of being feathered without tar; but if it merely favors the rapid proliferation of embryonic connective tissue cells, we are unable to see how any thing but the usual much-dreaded red elastic contracting cicatrix can be developed as a result of this kind of grafting.

It may be that the writer intends to teach that the embryonic connective tissue cell may be converted into an epithelium cell by the action of this membrane, but this is at variance with all previous physiological teaching, and if true would quite revolutionize all received doctrines of development.

It may be that the membrane, like the sponge in sponge-grafting, acts simply by giving support to the minute vessels which are concerned in building up the granulating surface of the wound; but while such a process would facilitate the filling up of gaps, etc., it is not easy to see how it could give any desirable covering to a skin-denuded surface of any considerable area.

If egg-membrane grafting is to be put forward as a substitute for skin-grafting, its advocates should surely give us some clear statement of the methodus medendi of the new procedure, and a name for the anatomical elements produced by it.

DR. GABRIELLE VON POSSANNER.

The editor owes an apology to Dr. Gabrielle von Possanner, of Vienna, for neglecting to give her credit for the article on Heil Serum, written jointly with Dr. Florence Brandeis, and published in the Practitioner and News of June 12th. He would gladly make amends for his unintentional error by publishing other articles from her gifted pen, culled from her large experience in the leading clinics and hospitals of the Old World.

Notes and Queries.

A NEW THEORY OF SLEEP.-Since the discoveries made by Golgi, Cajal, Retzius, and others, of the peculiar anatomical characteristics of the nervecells, a number of new theories regarding brain-function and brain-action have been in the field. The nerve-cell, as it is now understood, consists of a very large number of long-branched processes, which are called the protoplasmic processes, and a single axis cylinder which extends out, becoming eventually the nerve-fiber and giving off fine lateral branches. It has also been shown that each nerve-cell in the brain is in contiguity with some other nerve-cell, or rather with the terminals of the axis-cylinder process of that cell, but that no actual union takes place between the processes from the one cell and fiber process of the other. When one set of nerve-cells, for example, are thrown into activity, impulses are sent out along the axis cylinders and their terminal end-brushes, and these affect by contact the protoplasmic processes of other cells. Cajal and others look upon the axis cylinder and nerve-fiber as conveying impulses out from the nerve-cell or body, while the protoplastic processes receive impulses brought to them and carry them to the cell body. These latter, therefore, are sometimes called cellulipetal, while the axis-cylinder process is called cellulifugal. We are speaking, of course, now of the relation of the different groups of cells in different parts of the brain, rather than of the relations of these cells to the spinal cord and parts below.

Some time ago Professor Duval proposed the theory of sleep based upon the peculiar relations of the brain-cells and fibers. According to this theory the nerve-cells in repose retracted their processes, which, as he thought, were really pseudopods. The cell processes being thus retracted, the contiguity of the cell with other cells was less perfect, hence their functions became lowered, consciousness was lost, and sleep ensued. Kölliker objected to this view, on the ground that ameboid movements are never observed in nerve-cells, at least of the higher animals; Duval having contended that he had seen such movements in the lower order of animals. Cajal, siding with Kölliker, states that, no matter what way you kill an animal, by shock, strangulation, or anesthesia, the nerve-cells never differ in aspect, and one never can discover any ameboid movements among them, even when they are placed freshly in the field of the microscope. Cajal has, however, suggested another theory of sleep which he believes more rational and more in accordance with facts. While nerve-cells do not have ameboid movements, there are, scattered richly throughout the brain tissues, other cells known as neuroglia cells. These are cells with very numerous fine processes, and they form in a large measure the supporting framework of the brain tissue,