^, IMAGE EVALUATION TEST TARGET (MT-3) // 1.0 I.I 1.25 us 2.0 m 'AIL Photographic Sciences Cbrporaiion 23 WEST MAIN STREET WEBSTER, N.Y. 145S0 (716) 872-4503 \ SS'- ms^ \ '^.>. "S^'^^v^^.^ ^^^^' ■^ ! CIHM/ICMH Microfiche Series. CIHJVl/ICiVIH Collection de microfiches. Canadian Institute for Historical Microreproductions / Institut Canadian de microreproductions historiques Tachnical and Bibliographic Notaa/Notas tachniquaa at bibliosraphiquaa Tha Instituta haa anamptad to obtain tha baat original copy availabia for filming. 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Whenever poaaibia, these have been omitted from filming/ II se paut qua cartainaa pagaa blanchaa ajoutAas lore d'une reatauration apparaiaaant dana la taxta, maia. lorsqua cala Atait poasibia, caa pagaa n'ont paa iti filmiaa. Additional comments:/ Commentaires supplimantairas; L'Institut a microfilmi la mailleur exemplaire qu'il lui a AtA possible de se procurer. Las details da cat exemplaire qui sont peut-Atre uniques du point de vue bibliographiqua, qui peuvent modifier une imaga reproduite, ou qui pauvant exiger une modification dana la mithoda normala da filmage sont indiquAs ci-deaaoua. r~| Colourad pagaa/ D Pagaa da coulaur Pagaa damagad/ Pagaa andommagAea Pagaa raatorad and/oi Pagaa reataurAea at/ou palliculies Pagaa discoloured, stained or foxei Pagaa dAcolorAos, tachetAes ou piquies Pagaa detached/ Pagaa dAtachAes Showthrough/ Tranaparenca Quality of prir Quality inigala da I'lmpression Includes supplementary matarii Comprend du matAriai supplAmentaira Only edition available/ Seule Mition diaponible |~~| Pagea damaged/ pn Pagea raatorad and/or laminated/ r~y| Pagaa discoloured, stained or foxed/ I I Pagea detached/ |~~| Quality of print varies/ r~n Includes supplementary materiel/ |~n Only edition available/ 1 a 1 V d e b ri n n Pagea wholly or partially obscured by errata slips, tissues, etc.. have been refilmed to ensure the best possible image/ Les peges totalement ou partiallement obacurcias par un fauillet d'arrata. une pelure, etc.. ont M filmAes A nouveau de fapon d obtenir la meilleure image possible. This item is filmed at the reduction ratio checked below/ Ce document est fWmi au taux de reduction indiquA ci-deaaoua. 10X 14X 18X 22X 26X 30X ^ 12X 16X 20X 24X 28X 32X Th« copy flim«d h«r« Hm b««n raproduoad thanks to tha ganarosity of: MMlical Library MoGill Univaraity Montreal Tha imagaa appaaring hara ara tha baat quality possibia considaring tha condition and iagibiiity of tha orlginai copy and in Icaaping with tha fliming contract spacificatlona. Original eopiaa In printad papar covars ara filmad baginning with tha front covar and anding on tha last paga with a printad or illuatratad impraa- sion. or tha bacic covar whan appropriata. All othar original eopiaa ara filmad baginning on tha first paga with a printad or illustratad impraa- slon, and anding on tha laat paga with a printad or illuatratad impraasion. L'axamplaira film* fut raproduit grica i la g4n4rosit4 da: IMadieai Library MoGill Univaraity Montreal Las imagaa suhrantaa ont 4tA raproduitaa avac la plua grand soin, compta tanu da la condition at da la nattat* da l'axamplaira flimA. at an eonf ormhi avac laa conditions du contrat da fllmaga. Laa axamplalraa originaux dont la couvartura w* papiar ast imprim4a sont filmte an comman^nt par la pramiar plat at an tarmlnartt salt par la darnlAra paga qui comporta una amprainta d'impraasion ou d'illustration, soit par la sacond plat, salon la cas. Toua las autraa axamplalraa originaux sont fiimAs an commandant par la pramlAra paga qui comporta una amprainta d'imprqssion ou d'illustration at an tarminant par la darniAra paga qui comporta una talla amprainta. Tha last racordad frama on aach microficha shall contain tha symbol — »■ (moaning "CON- TINUED"), or tha symbol ▼ (moaning "END"), whichavar applias. Un daa symbdaa suhrants apparaltra sur la damlAra imaga da chaqua microficha, salon la cas: la symbola -4»> signifia "A 8UIVRE", la symbola ▼ signifia "FIN". Maps, platas, charts, ate., may ba filmad at diffarant raduction ratioa. Thosa too larga to ba antiraly Sncludad in ona axposura ara filmad baginning in tha uppar laft hand eomar, laft to right and top to bottom, aa many framaa aa raquirad. Tha following diagrams illustrata tha mathod: Las cartaa, planchaa, tablaaux, ate. pauvant Itra fllmte k daa taux da reduction diff^ants. Lorsqua la documant aat trap grand pour itra raproduit an un saul clich4. il aat film* i partir da I'angia supMaur gaucha, da gaucha i drolta, at da haut an baa, an pranant la nombra d'imagas nieassalra. Laa diagrammas suivants illustrant la mAthoda. 1 2 3 1 2 3 4 5 6 ^ EXCISION OF THE SCAPULA POR SARCOMA.' HY Francis J. Shepherd, M.D., Professoi of Anatomy and Lectiinr on Operative Surgery, McGill University ; Sur- geon to the Montreal General Hospital. The operation of excision of the scapula for disease is one of com parative rarity, so much so that I deemed it not unimportant to place on record a case in which I have lately operated. As far as I am aware no case has previously been recorded in Canadian medical literature. Lanorenlieck was the first to remove the entire scapula for disease in 1855 : the patient was a boy aged 12. In 1856 Mr. Syme removed the whole scapula from a woman aged 70, for tumour. Since then the bone has been occasionally removed for disease, but more frequently for injury. As far as my knowledge goes the whole upper extremity has been removed more often than the scapula alone, chiefiy because primary disease confined to the scapula is rare. The case relateeratlon, June ,J(ith.. — After being etherized the left arm was ■ Head before the Canadian Medical AsHOciation Montreal, August, 1800. d II bandaged and the parts about the scapula cleansed. An incision waS made from the acromion process to the superior angle of the scapula and continued down the posterior border to the inferior angle. The skin was now rapidly dissected away, and then the muscles attached to the spine and vertebral border were cut through, viz., the trapezius levator anguli scapulre and the rhomboids. Here the bleeding was free from the muscular branches' of the posterior scapular artery. The scapula w«is now lifted up and [the serratus niagnus muscle severed ani the vessels secured. To complete the excision of the lower end of the scapula, it was necessary to make a second horizon- tal incision at the base of the vertical one. The muscles attached to the superior border of the bone were now cut through, viz., infra spinatus, omohyoid and deltoid. The tip of the acromion being quite free from disease, was sawn through leaving the deltoid and trapezius muscles attached. The joint was now opened and the muscles of the axillary border (viz., teres major and minor, latissimus dorsi and long head of the triceps) detached, the end of the coracoid process was cut through with forceps, leaving the attachment of the biceps, coraco- brachialis and the pectoralis minor. The long head of the biceps was cut through when the joint was opened. The scapula and the tumour was now removed. The patient lost but little blood during the opera- tion, though there was much oozing, for which a rubber drain was introduced at the lower end of the wound. The patient made an uninterrupted recovery, the wound healing by first intention. A week after operation there was some rise of temperature and a fluctuating tumour felt ; this was opened and found to be synovial fluid secreted by the joint, which when reujoved inunediately relieved the symptoms. In two weeks the patient was out driving and left for home well on the IGth of July, but having her left arm in a sling. J)r. Wyatt Johnston who examined the scapula, reported that the tumour was a myeloid siireouui and confined to the infraspinous fossa. \