,.^.. IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I b£ 121 125 ^ 1^ 12.2 2.0 us L25 ill U. |||.6 ' 1 ^ M.II ^1 W "1 PliotDgraphic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 CIHM/ICMH Microfiche Series. CIHM/ICIVIH Collection de microfiches. Canadian Institute for Historical Microreproductions / institut Canadian de microreproductions historiques Technical and Bibliographic Notas/Notaa tachniquas at bibliographiquaa Tha Instituta has attamptad to obtain tha baat original copy avaiiabia for filming. Faaturas of thia copy which may ba bibliographically uniqua. which may altar any of tha imagas in tha raproduction. or which may significantly changa tha usual mathod of filming, ara chackad balow. □ Colourad covara/ Couvartura da coulaur r~~| Covars damassd/ D D D D D D D Couvartura andommagia Covars rastorad and/or laminatad/ Couvartura rastaurte at/ou pallicul6a □ Covar titia missing/ La D titra da couvartura manqua Colourad mapa/ Cartas giographiquas an coulaur Colourad ink (i.a. othar than blua or black)/ Encra da coulaur (i.a. autra qua blaua ou noira) Coloured platas and/or illustrations/ Planchas at/ou illustrationa an coulaur Bound with othar material/ RaiiA avac d'autres documents Tight binding may cauae shadows or distortion along interior margin/ La re liure serr^e peut causer de I'ombre ou de la diatoraion la long de la marge intArieure Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ II se peut que certainea pages blanches ajoutias lors d'une restauration apparaissant dana la texte, mais, lorsque cela itait possible, ces pagea n'ont pas itA filmtes. Additional comments:/ Commentaires supplimentalres: L'Institut a microfilm* la meilleur exemplaire qu'il lui a iti possible de se procurer. Les details da cet exemplaire qui sent peut-Atre uniques du point de vue bibliographique. qui peuvent modifier une image reproduite. ou qui peuvent exiger une modification dans la mithoda normale de filmage sont indiquis ci-dessous. |~n Coloured pages/ D Pagea da couieur Pages damaged/ Pages endommagias Pages restored and/oi Pages restaurAes at/ou paliiculAes Pages discoloured, stained or foxet Pages dicoiorAes, tachaties ou piquies Pages detached/ Pages ditachies Showthroughy Transparence Quality of prir Quality inigala de i'impression Includes supplementary materii Comprend du material suppKmantaire Only edition available/ Seule Edition disponible r~*i Pages damaged/ pn Pages restored and/or laminated/ FTj Pages discoloured, stained or foxed/ r~n Pages detached/ rri Showthrough/ I I Quality of print varies/ pn Includes supplementary material/ r~n Only edition available/ Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiailement obscurcies par un feuillet d'errata. une peiure, etc., ont At* filmtes A nouveau de fapon A obtenir la meilleure image possible. This item is filmed at the reduction ratio checked below/ Ce document est film* au taux da riduc^'on indiqu* ci-dessous. 10X 14X 18X 22X 26X 30X J 12X 16X 20X 24X 28X 32X Th* copy filmed h«r« has b««n r«produo«d thanks to tho gonorosity of: MMlical Library McQill University IMontreal Tho imago* appoaring hora tn tha baat quality posaiblo conaidaring tha condition and laglbllity of tha original copy and In kaaping with tha filming contract spaclficationa. L'axamplaira fllm4 fut reprodult griea i la g4nAroiitA da: Madieai Library MoGill Univariity IMontraal Laa Imagaa suhrantaa ont it* raproduitaa avac la plua grand aoin. eompta tanu da la condition at da la nattati da l'axamplaira film*, at an conformiti avac las condltiona du contrat da filmaga. Original coplaa in printad papar covara ara fllmad baginning with tha front eovar and anding on tha laat paga with a printad or illuatratad Impraa- sion, or tha back covar whan appropriate. Ail othar original copies ara fllmad beginning on the first paga with a printed or illuatratad Imprea- slon. and anding on the laat paga with a printed or illuatratad impression. Lee exemplelree origlnaux dont la couverture en papier eat imprimia sent fiimis en commenpant par le premier plat at en termlnent soit per la damlAre pege qui comporte une empreinte d'impreaaion ou d'llluatration, soit par le second plot, selon ki ees. Tous lee eutres exemplairea originaux aont filmis en commen^ent per la premlAre paga qui comporte une empreinte d'impreaaion ou d'illuatratlon at mn termlnent par la darniire pege qui comporte une telle empreinte. The laat recorded freme on eech microfiche shall contain ttie symbol — ^(meening "CON- TINUED"), or the symbol y (meening "END"), whichever appiiae. Un dee symboles sulvents epperettra sur la demlAre Imege do cheque microfiche, selon le caa: la symbole — ^ signifie "A SUIVRE", le symbols T signifie "FIN". IMeps, plates, charts, etc., mey be filmed at different reduction ratioa. Those too large to be entirely included in one expoeure ere filmed beginning in the upper left hand comer, left to right and top to bottom, ae many frames aa required. The following diagrams iiiuatrata the method: 1.08 cartea, planches, tableaux, etc., peuvent *tre filmie i dea taux da rAduction dlffirents. Lorsque le document est trop grand pour Atre reprodult en un seul clichA, ii eet film* A partir da I'angie supArieur gauche, do gauche k droite, et do heut en bes, en prenent le nombre d'imeges nicessaira. Las diagrammea suivanta illuatrent ki mAthode. 1 2 3 1 2 3 4 5 6 .. ^. ■r- i^T^^ Reprinted from the Montreal Medical Journal, December, 1S9S, m EXCISION OF HALF OF THE TONGUE. BY Georue E. Akmstrono, M.D., Associate Professor of Clinical Surgery, McGill University ; Surgeon to the Montren General Hospital ; Attending Surgeon to tlie Western Hospital, Montreal ; Consulting Surgeon to the Protestant Hospital for the Insane, Verduu. J. L., set G3, entered the Montreal General Hospital on Sept. loth, complaining of a painful lump on right side of tongue and difficulty in swallowing. About two years ago the patient noticsd a roughening on the right side of the tongue, about 1^ inches from tip, which caused no pain but did not disappear. Four months ago a little lump appeared on the right side of his tongue which pained him greatly and incon- venienced him in swallowing. For the last two months patient has not taken any solid food and during the last four months has lost flesh. Examination of the tongue showed, on the right side of the border of the tongue, a sinall hard indurated mass, about the size of a small bean, which appeared to involve the lingual nerve. Hot and cold liquids caused the patient pain. An operation was advised for removal of half the tongue by Butlin's modification of Kocher's method. Patient was prepared for operation on Sept. 21st. Etlier having been given, a preliminary tracheotomy was performed and a well- fitting canula introduced. The pharynx was then packed. An in- cision was then made tVom the mastoid process to the hyoid bone and thence along the anterior belly of the digastric muscle to the jaw, slightly to the right of the median raphe. The platysma was divided and the lingual artery ligatured as it passed under the hyoglossus muscle. The facial artery was tied, the submaxillary and lymphatic glands were then extirpated, all the lympathic glands carefully dis- sected from the anterior triangle of the neck, the mylohyoid muscle divided and the sublingual glands removed. The mucous membrane along the jaw, and the mylohyoid muscle was then divided. The tongue was split down the middle line, the right side drawn well out of the wound and excised well behind the disease. All oozing being stopped, the wound was closed, the tracheotomy tube left in and the pharynx freshly plugged. For three days the patient was fed by the rectum and after that by a tube throujjh the mouth. On the eighth day the tube was removed, and on Oct. 2.5th, the patient was dis- charged, cured, being the thirty-first day after operation. The patho- logical report was carcinoma of the tongue. This patient presented himself for inspection on the 1st December. The remaining half of the tongue lay in the middle of the floor of the mouth and was straight, not curled up ; it was moist, and materially useful in mastication and speaking. fc*;; ,/l 'P rt^ 1 /t:.' i :,is't: 1 ■> i;. •' > i ' I ■^ .'1 ,'S'f .* f . 1 ' • t: :.- '. :;^X V •' ' .'■ ■*- 4 4 J.;.'' . . N , ... - ) \ .-. ¥ ■ !:o ,•• ' r. , .. -i \ : ■.,; , ■ • .-fc.; ^^. 'y' , i " 1. » V'',. J ■ " i> ' ,' , ■'■'- ■.. ■ • 1 J - * .' ■' -s ■ • -fiiMit };■.( M] ii ^! ■ -/, l' ■ ■ ' ,■ - ; • t .; -■') -i ;.. >;' ,A ■ .-•^<,, • . ;;/ ' • ; . ' ■■■••. 'r\ ' • . 1 "-_; i"* V ■" ., ' : " V i f < /• ; ■;.,:?■ i. r ■."'•^- '; • ■ ' ■ ; I ' ' "" ■ -' . i Js..