Unusually large tumour of the jaw

One of the most remarkable operations carried out in the Royal Infirmary of Edinburgh during the early decades of the 19th century was the surgical excision of an enormous tumour, believed to be an osteosarcoma, of the lower jaw of Robert Penman, that produced severe disfigurement of his face. James Syme, then in his late twenties, was invited to see the patient by Professor Ballingall and Dr John Abercrombie and, in July 1828, he operated, without the benefit of an anaesthetic, to completely remove the tumour. The patient not only survived the operation, but also remained in excellent health for many years afterwards. 

The operation was performed with the patient sitting in an ordinary chair, and in all took twenty-four minutes. The patient bore it well, and did not lose more than seven or eight ounces of blood. His breathing was never in the slightest degree affected. 

Seventeen years after the operation, Syme was stopped in the street by the patient. He informed him that he had initially worked for a few years in Coldstream as a bootmaker, and then emigrated to New York, where he had remained for ten years, and that he had returned home to Scotland on a short visit. More interestingly, Syme noted that he was “no less surprised than pleased to see how little the operation had injured either his appearance or articulation. Careful inspection, indeed, was requisite to enable an ordinary observer to detect any thing peculiar in either of these respects”.

When aged about 16, Mr. Penman first consulted a local surgeon. He had a hard but painless swelling of the gum on the outer part of the left side of his lower jaw. At that time, it was about the size of a hen’s egg, and the surgeon extracted the adjoining teeth. The tumour, however, grew more rapidly and, when about the size of an orange, he attended the Royal Infirmary of Edinburgh. The tumour was “cut off from the bone” at that time, but the wound failed to heal. On this occasion he remained in the Infirmary for eight months. Over the period of the next two years the tumour increased rapidly in size.

Penman’s tumour weighed four and a half pounds (72 ounces) when operated.

Copies of the plaster of Paris mask made shortly before the tumour was removed are displayed in the Museum of the Royal College of Surgeons of Edinburgh and in the Anatomical Museum of the University of Edinburgh.

Engravings from the Edinburgh Medical and Surgical Journal 30, 286-290 (1828), showing two pre-operative views of the head and neck region of Robert Penman, whose facial tumour was surgically removed in 1828 by James Syme, assisted by George Ballingall. This was believed to have been the largest tumour of the lower jaw removed up to that time.

The plaster of Paris life mask of Mr Penam [Ballingall Collection, University of Edinburgh]