An Account of Some Extraordinary Tumors upon the Head of a Labouring Man, Now in St. Bartholomew's Hospital. By James Parsons, M. D. F. R. S.

XLII. An Account of some extraordinary Tumors upon the Head of a labouring Man, now in St. Bartholomew's Hospital. By James Parsons, M.D. F.R.S. Read Nov. 10, 1757. This poor man, whose name is John Tomlinson, gives this account of himself: That he was born at or near Rotherham in Yorkshire, and is now about 25 years of age: that when he was a boy of four or five years old, at play with other children, he received a blow from one of them upon the top of his head; and believes that hurt, he then received, was the beginning of the appearances, that are represented before you. See Tab. XIV. The tumor upon the top of his head, however, grew first, and, after having spread all over the vertex, extended gradually downwards over his right shoulder, and forwards over the os frontis, on the same side, till it stretched downwards into a lax flabby substance all over the right side of his face and shoulder: then the upper of the three anterior tumors arose from the large one; the middle one from the ala nasi, pulling it down by its weight, as you see it in Figure 1.; and the lower one was pendulous from the inside of the great tumor by a narrow neck. These are the appearances which present themselves at first sight; but those under the great tumor are no less extraordinary; for, upon lifting up the great tumor, and looking up * The two figures shew a fore and back view of this subject. under it, his right eye comes in sight, with which he sees very well, and the eye is clear and sound; but the under lid is pulled down, and stretched to six or seven inches long, to which a tumor hung also, as large as that anterior one at the chin, the lowest of the three; besides several flaps and rugae of skin, and smaller tumors. The hairy scalp is so stretched by the vertical tumor, that the hairs are driven asunder; so that the tumor is in some places bald, and the whole is rugged and uneven. At its basis, all round, till we come to the extended part that goes away to the right shoulder, a bony edge may be distinctly felt, as if the skull was depressed at the top: and yet I cannot but believe, that there is no depression of the arch of the inner table, because the man was from his childhood ever very healthy; being never troubled with those symptoms, which usually attend a depression of the cranium. From this seeming edge the os frontis shoots out a great way over the os nasus, perhaps to two or three inches beyond the frontal sinus's; and is the basis, from which the great pendulous tumor hangs downwards and forwards. From the root of the nose, under the upper of the three smaller tumors, arises a large trunk of a vein, which ramifies up to the vertical tumor, and to the right over the upper part of the great pendulous one: these are very conspicuous, and serve to bring back the residual blood from the tumors: nor is it unlikely that the arteries bear a proportion with these veins in their size, in order to supply the tumors with the matter, which has given them their great increase; but these, lying concealed, cannot be spoken to with any certainty. If we compare this growth of the frontal bone with that of other exostoses, I believe there may this difference be rationally observed; that other exostoses are generally attended with ulcerous tumors, which are for the most part cancerous; and these may commence at any age. I have now drawings, taken from the right hand of a man of 50, which represent risings of the radius and ulna, with the fingers, to a most frightful degree; and these begun but six years before, and are attended with foul running ulcers; and now the bones of the arm and hand, on the left side, are beginning to have the same appearances: whereas the frontal bone of the present subject appears sound, as far as we are able to judge by examination: nor does there appear the least disposition to ulceration in any part of it. When this is the case, the growth generally begins while the subjects are young; upon which we shall be more particular a little further on. His sensation upon every part of these tumors, is exactly like that of every other part of his skin, having not the least uneasiness upon being handled. This poor man worked at day-labour in the fields till some months before he came to town. Perhaps it may not be improper to lay down the dimensions of these tumors, as the case is so extraordinary; for the size of them is almost incredible: but I made my drawing in the presence of several of the gentlemen of that hospital, who allowed it to be very exact, and precise in the expression of the parts, as well as in the dimensions. The vertical tumor is about seven inches diameter at the basis, where the bony edge is felt, mentioned before, and about four inches high from that edge. From that edge, edge, or the basis of the vertical tumor, to the bottom of the great tumor, is ten inches; so that the length of both, from the vertex to the end of the great one, is about 14 inches: and upon viewing it, when he turns his side towards you, the whole mass is eight or nine inches over all the way; hard at top, and flabby downwards, hanging in kinds of plaits. From the eye to the opposite outline of the great tumor is six inches; and lower down, from the left corner of his mouth to the opposite outline of the same tumor, eight inches. The upper small tumor, over the nose, is one inch three quarters long by one inch and a half; the middle tumor is two inches long from the ala nasi, to which it hangs, and of the same breadth; and the lowest tumor, shaped like a goose's egg, is four inches and a half long by near three inches over. This man is under the care of Mr. Crane, an eminent surgeon of St. Bartholomew's Hospital, who has just now taken off the lowest of these three anterior tumors, and also the tumor mentioned, which hung underneath to the under lid of his right eye. He intends proceeding to take off that at the ala nasi next, and so on till he takes away all the smaller tumors first: afterwards the larger will be considered. The substance of those cut off was entirely fat; nor was there the least speck of blood in the lowest of the three smaller tumors; but there was an hemorrhage from a vessel divided in taking off that hanging to the right eye-lid; which soon yielded to the methods he made use of, and went on successfully till quite healed. It is pity no one of the people of condition in the country, country, where this poor man lived, took notice of him while he was a lad; because, when the vertical tumor begun, or even after it had made some progress, if he had been sent up to any of our hospitals, there would have been no difficulty in curing him. This leads me to some precautions, which, I hope, will render my account of the case of some use, considered in a physiological light; which was my intention in thus laying it before this learned Society. There is a great deal of difference between injuries received in young subjects and in adults. In the latter, the consequences are not apt to be of so dangerous a nature as in the former (except indeed where there happen violent fractures or wounds, which immediately dispatch the person, young or old); because, in such as are so far advanced in years, as that the parts have done growing, or, in other words, are incapable of carrying the person to any larger size, preserving the natural proportion, a tumor arising from a blow on the head would be merely local, without extending to any neighbouring parts in so extraordinary a manner: but in children, as in the case before you, a tumor may increase every moment from a blow, and spread itself to the neighbouring parts, to the ruin of the child, unless timely care be taken to prevent it; because in such young subjects the parts are continually growing, the vessels enlarging in their diameters, and carrying more and more nutrition to every point, in proportion to the nature of each individual organ, always preserving such an equilibrium, in the distribution of the nutritive juices, as is proper to secure the due proportion of every part as it increases: but when a tumor arises from from a blow in such a growing subject, if no wound is made, nor suppuration brought on in the tumor, then the parts of the tumor being only weakened, the equilibrium is destroyed, a greater flux of juices than ordinary is carried to it, the due resistance being impaired, and a luxuriancy of growth is produced in the place of the injury, which greatly exceeds that of the rest of the body; and will most certainly continue in the same manner, during the growth of the subject, when once thus begun. In the present subject, this luxuriancy was communicated even to the veins, which are apparent and large, and which were before, in their natural state, scarce visible; and not only to these, but to the very bones of the forehead: and as to the integuments and membranes of the body, their great distensibility is well known to every one. I have seen an ovarium so distended by water, and thickened as it grew, that it had substance enough to bear being dressed by a tanner, and contained nine gallons, which I saw poured into it after it was dressed. And does not every corpulent person shew the same power of distension in the membranes and integuments of the body, as well as wens of all kinds upon the surface? I thought so extraordinary a case well worth the notice of the learned members of this Society in itself; and the more so, as these few hints fall naturally from it, to render its publication useful. We are taught by this, how necessary it is for all such as have the management of youth under their care, to have an early regard to every accident that may befall children; for many times injuries of this kind have been thought very trivial, which, being overlooked and neglected too long, have been followed by very direful circumstances. I have known a young gentleman to have great hard swellings about his head, and become epileptic, losing his senses as he advanced in years, from a blow with the back of a book given him by a master. I am, with due respect, The Society's Sept. 18. 1757. Most obedient Servant, James Parsons. XLIII. An Extract of the Register of the Parish of Great Shefford, near Lamborne, in Berkshire, for Ten Years: With Observations on the same: In a Letter to Tho. Birch, D.D. Secret. R.S. from the Rev. Mr. Richard Forster, Rector of Great Shefford. Great Shefford, near Lamborne, Berks, July 8. 1757. Rev. Sir, Read Nov. 17, 1757. WHEN I settled in the country, abundant leisure enabled me to keep an exact parish-register. I have now finished ten years, I trust, with sufficient care, having examined every thing accurately myself. The sight of three letters, lately published in the Transactions, upon the subject of political arithmetic, put me upon over-