'iu ^^^S^ o /<>, ^'^ IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I t^jm |2.5 150 '"^^ IM9H ■U Ui 12.2 Slit ■ us us. mil 2.0 M i.25 ||||U 1 1.6 < ^ 6" ► *^ /: ? 7 y^ Photographic Sdences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 \ Technical and Bibliographic Notas/Notas tachniquaa at bibliographiquas The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographicaliy unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked below. Coloured covers/ Couverture de couieur I I Covers damaged/ D D D D D n Couverture endommagia Covers restored and/or laminated/ Couverture restaur^ et/ou pellicula I — I Cover title missing/ Le titre de couverture manque Coloured maps/ Cartes giographiques en couieur Coloured ink (i.e. other than blue or black)/ Encre de couieur (i.e. autre que bleue ou noire) Coloured plates and/or illustrations/ Planches et/ou illustrations en couieur Bound with other material/ Relii avec d'autres documents Tight binding may cause shadows or distortion along interior margin/ La re jiure serrie peut causer de I'ombre ou de la distorsion le long de la marge int^rioura Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ II se peut que certaines pages blanches ajouties lors d'une restauration apparaissent dans le texte. mais, lorsque cela itait possible, ces pages n'ont pas M filmies. L'Institut a microfilm* le meilleur exemplaire qu'il lui a iti possible de se procurer. Les details de cet exemplaire qui sont peut-Atre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dans la mithode normale de filmage sont indiqute ci-dessous. T! to □ Coloured pages/ Pages de couieur n Pages damaged/ Pages endommagtes D D D EShowthrough/ Transparence I I Quality of print varies/ Pages restored and/or laminated/ Pages restaur^es et/ou pellicui6es Pages discoloured, stained or foxed/ Pages dicolories, tacheties ou piquies Pages detached/ Pages ditachies Quality inigale de I'impression includes supplementary material/ Comprend du materiel supplAmentaire Only edition available/ Seule Edition disponibie Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiellement obscurcies par un feuiliet d'errata, une pelure, etc., ont M filmies A nouveau de fapon A obtenir la meilleure image possible. TI P< 01 fil O b« th si oi fli si 01 ; W M di er b< ril re m Additional comments:/ Commentaires supplAmentaires: Pagination as follows : [ 1 ] ■ 2, [ 1 ] - 2, [ 1 ] p. This item is filmed at the reduction ratio checked below/ Ce document est filmi au taux de reduction indiqu* ci-dessous. - J 10X 14X 18X 22X 26X aox J 12X 16X 20X 24X 28X 32X Th« copy filmad h«r« ha* b««n raproducad thanka to tha ganaroaity of: M«dical Library McGili University ■Montreal Tha imagaa appaaring hara ara tha baat quality poaaibia conaidaring tha condition and lagibility of tha originai copy and in icaaping with tha fiiming contract spacificationa. Original copiaa in printad papar covara ara filmad baginning with tha front eovar and anding on tha laat paga with a printad or iiluatratad impraa- sion. or tha bacic covar whan appropriata. Ail othar original copiaa ara filmad baginning on tha firat paga with a printad or iiluatratad impraa- aion, and anding on tha laat paga with a printad or iiluatratad impraaaion. L'axampiaira film* fut raproduit grAca A la ginAroaitt da: IMedical Library McGill University IVIontreai Laa imagaa auh/antaa ont iti raproduitaa avac la plua grand aoin, compta tanu da la condition at da la nattatA da I'aKampiaira f llmA. at an conformity avac laa conditiona du contrat da filmaga. Laa axamplairaa originaux dont la couvartura an papiar aat imprimte aont fiimte an commandant par la pramiar plat at an tarminant soit par la darniAra paga qui comporta una amprainta d'impraaaion ou d'illuatration. soit par la aacond plat, aalon la caa. Tous laa autraa axamplairaa originaux aont filmto an commanpant par la pramlAra paga qui comporta una amprainta d'impraaaion ou d'illuatration at an tarminant par la darnlAra paga qui comporta una taila amprainta. Tha laat racordad frama on aach microficha shall contain tha aymbol — ^ (moaning "CON- TINUED"), or tha aymbol V (moaning "END"), whichavar appiiaa. Un daa symbolaa auivanta apparattra sur la darnlAra imaga da chaqua microficha, salon la caa: la aymbola — ^ signif ia "A SUiVRE", la aymboia V signifia "FIN". l\Aap8, plataa, charta. ate, may ba filmad at diffarant raduction ratioa. Thoaa too iarga to ba antiraiy includad in ona axpoaura ara filmad baginning in tha uppar iaft hand comar, laft to right and top to bottom, aa many framaa aa raquirad. Tha following diagrama illuatrata tha mathod: Los cartaa, planchaa, tablaaux, ate, pauvant Atra filmia A daa taux da rAductlon diffAranta. Loraqua la documant aat trop grand pour Atra raproduit an un aaul cilchA, il aat f limA A partir da i'angia supAriaur gaucha^ da gaucha A droita, at da haut an baa, an pranant la nombra d'imagaa nAcaaaaira. Laa diagrammaa auivanta illuatrant la mAthoda. 32X 1 2 3 t t 3 4 5 6 k-s. 3^.^' Ja large mouth concretion-renal and vesi- . cal calculi.-an extreme degree of talipes EQUINUS. '^ JAMES BELL, M.D., Surgeon to the Royal Victoria Hospital. Reprinted from the Montreal Medical JourncU, April, 1897. I •:■> J< A LARGE MOUTH CONCRETION.' HY r Jamks Bei.l, M.D., Suifjeon to the Royiil Victoria Hospital. Mrs. G., ait. 32, consulted ine in September, 1800, for a large growth of long standing, which had tilled up the right l)UC{'nl cavity and had caused ulceration through the upper lip and great deformity of the face. The history was as follows: At the age of 12 years she had suffered from "fever," which had lasted a considerable time and had been followed by a slow convalescence, during which, she .stated, that the teeth in the right side of the lower jaw had become loose and dropped out one by one, but without any pain or ulceration of the gun»s. The teeth had all dropped out in about six months, and then she began to notice a " shell-like " mass on the gums from which the teeth had fallen, apparently in the area occupied by the molar teeth. For ten years this growth was gradual and gave her practically no trouble. Then deformity of the face began to be noticeable and increased steadily. It was, however, only within the last year that marked increase in the size of the mass had been observed and troublesome symptoms had developed. On examination, the growth was found to fill the whole right cheek and to have produced great flattening of the right side of the face and the right nostril. It had ulcerated through the upper lip at one point, and the whole lip was greatly swollen. The point which presented at the angle of the mouth was evidently calcareous, but I mistook this for a simple coating of calcareous matter. The fetor was horrible and the mouth was so sensitive that no manipulation was possible. I looked upon it as a growth from the upper alveolar bordei*, probably originally of the nature of epulis, but having recently (coincidently with the history of rapid increase in growth and symptoms), became malignant, and advised removal of the upper jaw. She went home, but returned and was admitted to the hospital on October 12th and prepared for operation on the l!)th. When she was fully anaesthetized, I was able, for the first time, to make an examination of the mouth. I then f(jund, to my surprise, that the mass consisted simply of a large con- ci'etion the size of a large hen's -ego;, lying free in the mouth, hav- ing formed a cavity for itself by displacement of the soft parts and ' Shown at the meeting of the Montreal Medico-Chirurgieal Society, October Kitli 18Mi. y\ "-ere embeddld ; ' •7"' '=°»«M«'-«ble diffleX , T '° '"•«« ^3^ cm. in it, : ^^^ '"♦^««. which was ov«] u ""°^ *'^« f w- It was so large A couple of teeth early an enormous t'on of the mouth f^a'-ged in a week ^urred during the a shape, measured fJ its smallest cir- I RENAL AND VESICAL CALCULI' ItY 1I0^' .lAMtJS Bkm,, M.D., Surgeon to the Royiil Victoriii HoMpitiil. (1) A larj]fe brancheil calculus roinoved from the ri^ht kidney. The patient, 42 years of ago, a strong, active and healthy man and a free liver, was attacked with fever and general nialaise on the 28th of July, 189G, while on a fishing excursion. About the 11th of August he began to have severe chills and was seen by a physician, who found a large amount of pus in the urine and a tender mass in the right lumbar region. He was seen in consultation by Dr. Bell on the 24th of August, who confii'med the diagnosis of right pyonephrosis, probably calculous, and advised operation. The patient did not con- sent until the Hth of September, wlien he was admitted to the Royal Victoria Hospital. He was then in a condition of general septicaemia, with riuid in both pleural cavities, an exhausting diarrhci'a, daily chills, followed by profuse perspiration and tremendous rises of tem- perature. His condition was so bad that nothing was done until the 18th of September, when the kidney was exposed in the loin in the ordinary way. It was very firmly adhered posteriorly, and, when isolated, was very large and f edematous. The pelvis was distended and contained a quantity of pus, which was evacuated, as well as a large abscess, which was situated above and in front of the kidney. The mo.st careful exploration failed to discover any stone. The organ was palpated between the fingers from end to end, needles were intro- duced into its substance at several points and a short beaked stone searcher was introduced into the pelvis and directed up towards the calyces, with the fingers of the other hand upon the convexity of the kidney. The conclusion was therefore arrived at that the suppuration could not be due to a calculus. The wound was left open and a drainage tube was carried up into the perirenal abccss cavity. The patient's condition improved very markedly, but the urine still con- tained pus ; there was always some fever and there was a free dis- charge of pus from the wound. On the 27th of November the •ound was reopened for exploratory purposes and with the intention I .emoving the kidney if necessary, when the calculus now exhibited was found imbedded in the sub3tanco of the kidney at its lower 1= i^xhibited at the meeting of the Montreal Meclico-Chirurgical Society, January J li cxtroiiiity, tlu> |)()int of tlu' sttnu* being directed dctwii towards the pi'lvis of the kidiu'y. BVom this tiiiu? pus disappi'iired from i\\i' uriiu', except in micro- scopic <|uatitities, an