^^ ^> IMAGE EVALUATION TEST TARGET (MT-3) ///// ^^ c*'^ '^4£ M ^ 1.0 I.I lis 2.2 1^ I" 1^ ^ - lis lllllio L25 lllll 1.4 - 6" lU 1.6 V] V] /: c% //a Sciences Corporation ^^ #> V \\ 4^ O^ <> '^" ~<b"- 23 WEST MAIN STREET WEBSTER, N.Y. MS 80 (716) 872-4503 :<? -^x -.V'"^^- i/.x CIHM/ICMH Microfiche Series. CIHM/ICMH Collection de microfiches. Canadian Institute for Historical Microreproductions / Institut Canadian de microreproductions historlques 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 biblijgraphically 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 couleur □ Covers damaged/ Couverture endommag6e □ Covers restored and/or laminated/ Couverture restaurde et/ou pelliculde □ Cover title missing/ Le titre de couverture manque I I Coloured maps/ Cartes g^ographiques en couleur □ Coloured ink (i.e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noire) L'Institut a microfilm^ le meilleur exemplaire qu'il lui a 6td possible de se procurer. Les details de cet exemplaire qui sont peut-dtre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dans la methods normale de filmage sont indiqu^s ci-dessous. □ Coloured pages/ Pages de couleur I I Pages damaged/ D »/ Pages endommag^es Pages restored and/or laminated/ Pages restaur6es et/ou pellicul^es Pages discoloured, stained or foxsd/ Pages ddcolor^es, tachet^es ou piqu^es Pages detached/ Pages d^tachees Showthrough/ Transparence D D n n Coloured plates and/or illustrations/ Planches dt/ou illustrations en couleur Bound with other material/ Relid avec d'autres documents Tight binding may cause shedows or distortion along interior margin/ Lareliure serr^e peut causer de I'ombre ou de la distortion le long de la margi intdrieure 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 ajout^es lors d'une restauration apparaissent dans le texte, mais, lorsque cela dtait possible, ces pages n'ont pas 6t6 filmdes. Additional comments:/ Commentaires suppldmentaires: □ Quality of print varies/ Qualiti indgale de I'impression I I Includes supplementary material/ D D This item is filmed at the reduction ratio checked below/ Ce document est film6 au taux de reduction indiqud ci-dessous. Comprend du materiel supplementaire Only edition available/ Seule Edition disponible 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 feuillet d'errata, une pelure, etc., ont 6t6 film6es d nouveau de facon d obtenir la meilleure image possible. 10X 14X 18X 22X 26X 30X J 12X 16X 20X 24X 28X 32X s The copy filmed here has been reproduced thanks to the generosity of: IVIedical Library IVIcGIII University IVIontreal The images appearing here are the best quality possible considering the condition and iegibiiity of the original copy and in keeping with the filming contract specifications. L'exemplaire filmi fut reproduit grAce A la gAn6rosit6 de: IMedical Library IMcGill University Montreal Las Images suivantes ont ttS reproduites avec ie plus grand soin, compte tenu de la condition et de la notteti de l'exemplaire fiimA, et en conformity avec les conditions du contrat de filmage. 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. Les exemplalres originaux dont la couverture en papier est Imprlmte sont filmte en commenpant par ie premier plat et en terminant soit par ia dernlAre page qui comporte une empreinte d'Impression ou d'illustratlon, soit par ie second plat, salon Ie cas. Tous les autres exemplalres originaux sont fllmte en commenpant par la premiere page qui comporte une empreinte d'Impression ou d'illustration et en terminant par ia derniire page qui comporte une telle empreinte. The last recorded frame on each microfiche shall contain the symbol -^►(meaning "CON- TINUED"), or the symbol y (meaning "END"), whichever applies. Un des symboles suivants apparaftra sur la derniire image de cheque microfiche, selon ie cas: Ie symbols —*- signifie "A SUIVRE". Ie symbols V signifie "FIN". iVIaps. plates, charts, etc.. may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Los cartes, planches, tableaux, etc.. peuvent Atre fiimis i des taux de reduction diffirents. Lorsque Ie document est trop grand pour dtre reproduit en un seul clichA. 11 est filmi d partir de I'angle supArieur gauche, de gauche A droite, et de haut en bas. en prenant ie nombre d'images n6cessaire. Les diagrammes suivants illustrent la m6thode. 32X 1 2 3 1 2 3 4 5 6 s c T IK ^ ^ I F,i^<^- K-L~ SCIATICA AS A ^— COMPLICATION OF CARCINOMA. BY ROBT. C. KFRKPATRIOK, M.D., Assistant Surgeon Montreal General Hospital. (Reprinted from the Montreal Medical Journal, March, 1894.) SCIATICA AS A COMPLICATION OF CARCINOMA.* By RoHT. C. KiRKPATRicK, M.D., Asst. SnrK. Mont. Gen. Hosp. We have all met with cases of carcinoma in or about the pelvis, in which there was, as a prominent symptom, pain down the course of the sciatic nerve. These, however, are not the cases I mean when I speak of sciatica complicating carcinoma. Such cases can be explained, either by direct pressure of the tumour upon the nerve or by invasion of the nerve by the contiguous cancer. In the cases I wish to bring before you to-night the cancer was situated at a distance from the nerve> and, in two in which autopsies were performed, no tumour of any kind was found in the abdomen or pelvis. The cases are three in number, and the histories are briefly as follows : — Case I. — Mrs. H., aged 36, came under my care in May, 1892, suffering from a severe sciatica on the left side. At that time there was inability to move the leg on account of the pain, and the affected thigh was one inch less than the other in cir- cumference. There was marked tenderness down the course of the nerve from its point of exit nearly to the knee. She also complained of a swelling in the right breast. Twelve years previously a crochet needle had been run into the breast, and a year ago this tumour appeared as a small nodule at the site of the old injury. It had increased until, when I saw her, it was the size of a lemon, and extended from the nipple upwards and inwards toward the sternum. The nipple was very slightly retracted. The growth was hard, not movable over the sub- jacent tissues and the skin over it was reddened. There was also present a thickening and enlargement of the joint between the first two pieces of the sternum, a symptom which has been pointed out by Snow as of frequent occurrence. The tumour was removed by the usual operation, and proved to be a scirrhus carcinoma. The axillary glands were not enlarged. A vaginal examination was refused, but no abdominal tenderness or tumour could be made out externally. The patient shortly afterwards left the city and was lost sight of. * Read before the Montreal Clinical Society, November 11th, 1893. 3 Case II,— A. G., aged 41, entered Montreal General Hospi- tal January 10th, 1885, complaining of inability to move left leg without great pain. She had a large ulcerating carcinoma of left breast, on account of which she had been in the hospital before. While leaving hospital the last time this pain had come on and remained ever since. She died February 10th, 1885, and at the autopsy no secondary deposits were found anywhere in body. Case III.— W. S,, aged 60, was admitted to Montreal General Hospital, February 4th, 1886, complaining of cough, shortness of breath and pain in the chest, coming on about four months previously and gradually increasing. The physical signs were dullness over the lower part of front and side of right chest, with diminished respiration and coarse friction sounds. He was weak and kept to his bed. In April he developed sciatica in hi? left leg, and about a fortnight later in the right leg. He died May 24th, 1880, and at the autopsy was found a primary carcinoma of the right pleura, with secondary deposits in the lungs, liver, kidneys, and left supra renal capusule. There was no enlargement of the retroperitoneal gland;?, nor any apparent deposit about the nerve. In these two latter cases there was unfortunately no exami- nation made of the nerve microscopically, therefore the cause of the pain is left to conjecture. It is to be observed in all three cases the absence of any of the usual causes of sciatica, exposure to cold, rheumatism, pelvic or abdominal tumours or disease of the spine, and the pain came on before the patient had become much debilitated. In the first case, the pain came on when the patient was getting into bed, and came on so suddenly that she thought that something had broken or got out of place. The second patient had been confined to bed for some time and presumably had improved in health, for she was going down stairs prepara- tory to leaving the hospital when the pain came, slightly at first and gradually becoming more severe, until she was unable to move the limb. The third case had been in bed for two months when the pain appeared, and possibly asthenia may have been a causative factor here. The only suggestion I can make as to the cause of the pain is that secondary deposits took place within the nerve itself, prohably about some of the arterioles, and by the irritation and pressure produced by their presence, set up more or less neuritis, or the same condition may have been produced by some of the products of the cancer circulating in the blood. All these cases proved most rebellious to treatment, local and general. The affection was so severe that the patients wore conBned to bed and were obliged to remain at rest. The com- plication is comparatively rare, but it seems to be more than a mere coincidence that this nerve was picked out in all the cases, and I have no doubt more cases would be found were an inquiry instituted with that end in view. An interesting point in the history of the second case, is that during her first stay in the hospital she had an attack of erysipelas, after which the carcinomatous ulcer healed to a great extent.