CIHM Microfiche Series (l\/lonographs) ICIMH Collection de microfiches (monographies) Canadian Institute for Historical Microraproductions / Institut Canadian da microreproductions historiques Technical and Bibliographic Notes / Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked below. L'Institut a microfilmi le meilleur exempiaire qu'il lui a iti possible de se procurer. Les details de cet exempiaire qui sont peut4tre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite. ou qui peuvent exiger une modification dans la mithode normale de f ilmage sont indiqu^ ci-dessous. □ Coloured covers/ Couverture de couleur Covers damaged/ ^ I Couverture endommagie n n D D n n Covers restored Couverture rest =f < r.' atad/ » e*to'. elliculfte Cover title missingy Le titre de couvertur .'iue Coloured maps/ Caites gtographiques en couleur Coloured ink (i.e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noire) Coloured plates and/or illustrations/ Planches et/ou illustrations en couleur Bound with other material/ Relie avec d'autres documents Tight binding may cause shadows or distortion along interior margin/ La reliure serrte peut causer de I'ombre ou de la distorsion le long de la marge interieure □ Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ It se peut que certaines pages blanches ajouttes lurs d'une restauration apparaissent dans le texte, mais, lorsque cela etait possible, ces pages n'ont pas ete filmtes. □ Coloured pages/ Pages de couleur BZ. damaged/ endommagies □ Pages restored and/or laminated/ Pages restaurees et/ou pelliculies Pages discoloured, stained or foxed/ Pages dicolories, tachettes ou piquees □ Pages detached/ Pages detachies 0Showthrough/ Transparence □ Quality of Qualite in< D print varies/ egale de I'impression D Continuous pagination/ Pagination continue Includes index(es)/ Comprend un (des) index Title on header taken from: / Le titre de I'en-tCte provient: □ Title page of issue/ Page de titre de la I □ Caption of issue/ Titre de depart de la li livraison vraison □ Masthead/ Gener ique (periodiques) de la livraison n Additional comments;/ Commentaires supplementaires: This Item is filmed at the reduction ratio checked below/ Ce document est filme au taux de reduction indique ci-dessous. 10X 14X 18X 22X :6x 30X M I I I I M I! ! M U I 12X 1SX 20X 24 X 28X 32 X The copy filmed h«r« ha* been reproduced thanks to tha ganeroaity of: L'axamplaira film4 fut raproduit grlca * la 9*nArosit* da: University of Toronto Archives University of Toronto Archives The images appearing here are the best quality possible considering the condition and legibility of the original copy and in Iteeping with the filming contract specifications. Original copies in printed paper covers are filmed beginning with the front cover and ending on the last page with a printed or illustrated impres- sion, or the back cover when appropriate. All other original copies are filmed beginning on the first page with a printed or illustrated impres- sion, and ending on the last page with a printed or illustrated impression. The last recorded frame on each microfiche shall contain the symbol — »■ (meaning "CON- TINUED"), or the symbol V (meaning "END"|. whichever applies. Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large tc be entirely included in one exposure are filmed beginning in the upper Itft hand corner, left to right and top to bottom, as many frames A required. The following diagrams illustrate the method: Les images suivantes ont M reproduites avac la plus grand soin, compte tenu de la condition et de la nettet« de i'exemplaire film*, et en conformity avec les conditions du contrat de filmage. Les exemplaires originaux dont la couverture an papier est imprim6e sont film^> signifie "A SUIVRE", le symbols V signifie "FIN". Les cartes, planches, tableaux, etc., peuvent fttre fiim^s i des taux de reduction diffirents. Lorsque le document est trop grand pour Atre reproduit en un seul clich«, il est film* d partir de I'angle supirieur gauche, de gauche i droite, et de haut en bas, en prenant le nombre d'images nicessaire. -Les diagrammes suivants illustrent la m*thode. 1 2 3 1 2 3 4 5 6 ^iU ti, OLUJ:*^ (^^.c^LMlc^juU- P<#|^p<>0<>6<>p<>p< I. A NEW METHOD OF CUTTING URINARY CALCULI. 2. A CASE OF UNUSUALLY LARGE CALCULUS REMOVED BY SUPRA- PUBIC SECTION. j» .* J» .* .* .* .* ...in ... C.l'.DUC.i: A. riCTI'.kS, M.l! , I'.U.C.S. I'M. T.iKONTd C.\N.\I)\ ll'-lti ill!' 1 Ifirii Till ( ■ \\ \iii \\ 1*1; \< 1 1 1 ni\i;i- \ M. l:i \ 11 w , .l.inil.ir.v . P«..'. '?^">o?>^%?^/%?%?IIW^>o?%?>T6o< >o< /^ T J. A NEW METHOD OF CUTTING URINARY CAL- CULI. 2. A CASE OF UNUSUALLY LARGE CAL- CULUS REMOVED BY SUPRA-PUBIC SECTION. lU I.KillK.K \ I'KI'Kl:.-. Ml!.. I- I! 1 .S lAi. . \-,.,..|.„,. r, .1 i-..:^>ir. I, 11. I rl,,ii.-.l s i,^,.rv I '">'i-'l> ..f T..r..Mi.. . -mw- T'lr-iii.. Lviirr^il ll..-|'il..l . 1 \ in, .1-1.1 ll"-|.ii il I" n.il.lrr... T.'r.iil" 'I'lic lollowiii;;- In il iiirtlKHl ul' ciitiiii-' >lun,'.s cil' all ' 'II.!.--. lianl ami .sdlt. wliicli tlir iiiuhur liiis fouiiil to !>• of j^ifiit iim' au'l ol .■.|ii,il siiiililicity. Solar as i-.iii 1p<' msci rtainf(l tlir iiu'IImhI i- iii\v ami ori^niial. 'I'll.' stiiiif is first of all iliiii>i'il tor a iiioiiifiit into iiirind l>aratHii was. 'i'liis i;ivfs it a very tliiu foatiiiu' ol' tlu' \v,i\ iKi;^. 1 K) and i.i-.'voiits the stickiii- of plasi.i-of-l'.iris in uliicli it is to 1 iiibcd.lf'l. As a means of lioldiii;; tli.' stonr al)>oliitily iiiiinoxalil.' wliih' il is iuMiii; .sawn, the aid of a liors,.- slio.., as sli.iwn ill till' iKroiiiiiiiiiyin;; illustration (V\. is liroii-ht into use. 'ni.' Ii.n'scsho. ^ i.lan-d nipoii a hoard witli its u'l^iddlf fsactly ovn- a liii.- i r'i^'. 1 -V ) juvviously drawn loiij,'iHliliiially iqioii tlh' lio,inl. 'i'liis linr is t.. s.tvc as a constant tixt'd indication of thr nntro of the stone. 'I'tie lieels (,f the lioi-.Msline ni.iy h-' tilted 11]) l>y means of a short 111' ifU ({•'i- 1 i'.liilaced crosswise iiiid nnw taken iiilo thr hands of tl i.er.ilor .and can-fully c.iitrali/i'd opiMPsite ill.- line drawn on tie' ho.-ird IMasli'i-of- I'aiis cream is then run round il .ind .>\er il in such a way as lo eiiihed th'' stone COIllpletelv to the .■xt.nl of not 1,-ss lli.ni |,,.,||- ,,,|| incli of eovcriii-- at any liail, and in such .i in.inner thai ihr cmhe.ldln- iilast>-r ,al,so cmliracs ih- hr.-l- of the hor>esho.- , ..-1111.1 .11 ■! Ill ,■1-1 111.-. .1 lli.-'l-.ii-.iiilo 1'h11i.i1..ki.mI s,i,-„-lj, N,iri'iillHM-L'. I'.fil. 4 n TTrNfl OF lUINAIiV lALClLl. (Fig. 1 l>». i'he plastti- is then iillowfd to nvi (irmly, ami if it fiiii be left fur sevenil liayM until it is thoroiijfhiy dried so iiiucli the lietter, iis it is found tliiit the siiw works more easily in thorou;;lily ilry plaster. The stone is sawn directly through the plaster which embeds it in the line previously marked on the board, and a second cut is made throiigli the plaster between tlie stone and the heel of the hor.seshoe. If the stone is very large and hanl, the Iward may U' fastened in a vice, and tlrj saw cut made through the Ijoard al.so. This .serves very materially to stea ly the .^aw. This section thus liberated can then be readily detached from the lx)ard and will be found to contain one-1-alf of the stone, which '.in I asily lifted out of the embedding plastei'. part of which may lie cut away (Fig. 2 Ft. The removal of the stone from the piaster is facilitated by i)lnnging the wliole into hot water lor a few moments, when the ])urat!'n wa.x becomes softened iuid the stone can thu.s be .'asily separ-ited from the plaster. The last trace of wax is then melted otl' liy holding it under a hf)t water tap, or putting it into a basin of hot water for a few moments. The cut surface of the stone may be polished rapidly and easily by grinding it on a ground-gla.s' surface. In theca.se ul' ver}- hard stones the |iolishing process is facilitatecl by using powilered ])umice stone or emi'ry, (hough this is seldom necessary. In order to get a highly polished surface the stone should tinally be rubbtij on dry. plain glass, .ind CirilNIi |)li('iililr to thf Imri'v I oxiilatf of linii', as well lis to the sol'tust plinspluiti'- stones, nnil even to ;;iill-stones It is ini|)<)ssilile for the stone to fnicttire The only case in which iiny ilirticulty was ever experiencol was one in whicti a very hard oxalate of liiue niicl"ns was surrounded liy a layer of phosphates of very loose forniution, around which a;;ain was a more dense ph• s su with a fair iiiiiounl of .set answiis adiiiinihi, . Houlii i\. n^ tliickened hack, as is found on most suryficjil .< '\SK n,.- I Till' ^pl•(•i||len lisrd I dc-cribi'd iihove is a urinarx this era and this country circuiiifeii'iice in the loiii;! siiiirtcr diaiiii'ier •'> ■ iiidies idiapi'. Iieiiiij Nli;,ditly lai_ somewhat llattenecl. Its > ounces and 2:!0 ■riains. ■ \i ■ ' MS. .t ii.id of ' ittini.' 'lally larj.'!- -i/.-j for not coninK Its incht's: ill itir ,1, ^\ iiimeti'i- il • 'val •id !ll '!" "tleT Hid t iMir ■ al wn < !• CI ITIN"; "I lUINAKV CALfl I.I Till' licwt \\;isa rairiiiT, Mr, . 'tlif .isc stroll;; and Inalthy, a;;!' ;t!>. Iti- Ii'kI Im'cii iIk' Miihji-ct '>'' yiiiptoiiiH uf ,«.t"iiir in tlir liliiil'l. r I'liiiii tin.' ii;;'- III' alxmt 9 yi'iirn. At times it proiliici'l iiiiicii piiiii, 1)111 iiitti'i-ly tlic Nviuptoiii'- liud lurply siiiisiilfd, ami lir ivally Hiirt'eivil Imt littk'. This wuh explained lit the tirniMil' Dpeiatiiin liy the I'net timt the stiilie hiid lieconn' p.iiTially eiicystetl, Hiid thus was iiiiiiiovalile in the hhidder. 'I'h(( eiilciiiuM was removed hy supra-puliic cystotomy on the 1st of .flllle, IMOI. (Ill opeiiini; tlie liiiidder the stone was I'oiind with its lar;;e end upwards, and its siimller end eiiiheddeii to a siijjht extent in the fundus of tiie ''ladder behind the proMtjili'. 'I'lie wound in tin lijadih-r wall wa. iiade lar;;e enoui.di to mIIuw the stone to 1(0 removeil without undue lacera- tion. .\rter reiiiova! the bladder was llushed out and stiti!i"d ep with two rows of chroniicized catijul sutures. The etli.id I'liipliiyed for disteiidiii;^ the bladder before deration v -- iiiat .idviK'ated by Urei;; Smith, viz. by attaci ■ tin- tab. if a resei\i)ii' at an ele\a* i of aUait '1 ft to a cutrieter intro luci d into the liladder, and after stitt'hin;; up the ineision, the bladder was tested for the accuracy of the suturing; by allowing,' it to bi come distended tlirouj^li the catheter. .V tube surrounded by a layer of ;;aii/e was used for drainaj;e down t<,>. but not into, the bj.icldi'r. The patient had no bad syinptoiiis whate\er, and the bl,ii|i|er wound hea'ed by tii'st intention, so that at the end often days then- was no leaka;,'e whatever. I5ut shortly after this a \cry small leaka^^e oceiirred uiid persisted for some time, ulti- iii.itely hialiiiLf however, and leaving; a ;,'oo- wliicl. ,iiv |„,,„| l;'""'i- sul..,.....,.,. „ |,i,,, i, ,. ,,^^^_, til.' I noiv ,||.|i.si. [)|| IHIIIIIIII 'm-ul»rly.|iHtnl,„t,..|| ^<'lw. ••'ills till plilllHil,! in tl •••" t"att,.,„,,ti,,,v,„|„l, '"'"■•' «" t-n ill .tun, "t Me. .I,,„atlmii Mutcl y --uiMiis.- (Ill HII witli i"*< i-ase til., aetiial oi, iHers lial.itiiHllv I |'ll<<\vin;r |,j„, 'I tl llllsiiii '"•y. Hiiici) "" I'HN.V ,,||,. ,„i^,l|, A 111. I, from 4 '.f course iiiiptTleot assiii ri Ills ur' '■'"" '''•'•"iij;fiii,.|,| or th- .|.-,r ■■■''"';;;" Ut.wtious .i,.,K,,siN \l-hil.. .* . ' "> ( vi'iuN i,r H-'f. :'': """*:• "■""- "'—"-r lie s„h; "'"' ''I'l-'iin;,' ,,,iin Hit 'Xilllltt |.;»*s«s |-..,- invtli n |)lSsit,;r i,,.;,,^. ; „, •FM I' ij'ustiv.. ..r<,'uii.s. an- CDiiiiiiuii I'DIII ■H HI ..XC-SS, Uy ,,,„, ,,^. ,^^, , iciitiii' i.is r '•lll.litij; deletion of "■ l'"'"*"^'- "»■ tiles., calcl -;."^r..u-M.uiija....,,„„,, ,'; "111 colic iiti!l j),:.|.| '"■ ""••'■'weopic .|ii;,ntit 1 r- IfS, ■■"•f..iii|,a.,i,.,| 1,^. i,|,„„, 'nips ""'• '•alciili. ""<■ I.U.|<|.st ''!•« in its -rowth ■ prohahl, ^„.^ ,^^, , lei- or (; v. an. I ph.)sphat..s f, la_\-er of urate: '•'•ii.ain.le, of th.. :'jo ,.,j,'| ''"'"' ^l"- -lin-s of ,.|,os,;| ni^' layer outside of ••""I that th.. .1 this possibly in.li "•.■siiltinif i 'i-ate atta..|v-s of mil,! orrninjr th,. crust y.irs of t|„. lij.,. ^^^. 'pl'at.-s throii;rhout th '••I'<»*its of th,. oeeupii.(l the tl n ciir... .liatl If one shouM pre.lic; ■yxtitis. calliier f, lis caleuhis St, in. nia\' r it.st of o.\alut..of I inark-i.,1 , liatl " COIKjit to tl "■-■"^ ."'tl'is,n.Iivi,lual,th,.,.| une t.) the ,| laii''.. •ite a '>ni tl I.I lit. tie re\e l'-I>osit of ,„.,it,,^ ,j "a'k(.ti oxalat.. '<'I)i-eeipit,rion lor >< as re.'nr. Is ,1 ■''■<"'• for Hutel, ofs not iii.li iiisoii leai 'O'^'' Hhieh pro,lur.. i hf't, pfo.lue,. th ''■'■an;rei„em "icaei.l, i points ,,„t flat '^'ostive p.Mver siniil It eoxalat,.s"an,l ■ay uii,!,.!- sli.riit lar i"'f''ration of '^ an i'xtraor.linar\- f thoufjh th.. oxalat.. eal hemorrhai:.. ar.. not, iU't, as Iculiis is r ''>;''mplirie(J in tl I I ia\e as a rule, ■oil;rh an.l v,.,-v 1 11^ ease, t|,,i, eaiis,. it is /*pol«'ii of this stori pi"omin..nt -ynipt i..av\- OIIIS. pam and >f the larffi.st e as one of (11 if not tl "Usual size I,,.. ''"■,i;''st, that C'l'TTINC; <»K lUINAUY ('AIA'11,1. Iiiis cDiiii' iiikIci- my nliMTvatioii in tliin coiliilry iis Imv- iiii' l)fiii n-iiuivfil l)y i)|w'r:itioii. Stoiii' is r.iri' in <"inmilii lis compareil with Kurojicaii iiiul Asiatic countries, and it is hut dill' t() tlie medical iirofession in Canada to say that when presint it is usually iliseovered and icmoved ln-rorc it ri-achcs any such dimensions as this specimen exhihits. Ihit tiiis is a small stone compared to some recordeil eases. Hutchinson >,'ives the following iw .some of the largest removed during life : A stone measuring in girth l(i^, x 12^, inches, Ctterhavens ; Hunter, (Madras) weight 2'i ounces: Morri.son, (Northumber- land) weight 1 pound ii'l oniici-s: Sir Henry Thompson, weight 14 ounces, (avoir). lif.' I'oi.i.KiiH St.. ToiiovTo.