A Century of Progress
The text and photographs on this page are excerpted from a four-volume series of books titled Oncology Tumors & Treatment: A Photographic History, by Stanley B. Burns, MD, FACS. The photos below are from the volume titled “The Anesthesia Era 1845-1875.” To view additional photos from this series of books, visit burnsarchive.com.
Slow-growing benign parotid gland tumors were highly visible lesions only brought to a surgeon’s attention when complications arose. Successful removal of these tumors was often recorded and photographed to verify the competence of the surgeon and enhance his reputation. This series documents one such case and is one of the first cases published with pre- and postoperative photographs. The case report included tipped-in photographs and was presented in Revue Photographique des Hôpitaux de Paris, volume 4, 1872. This was the world’s first medical journal to illustrate cases with photographs. It was published from 1869 through 1874. The photographs accompanying the articles were pasted on separate pages. Dr. Cauchois, interne des Hôpitaux de Paris, reported the case:
On February 8, 1872, Mr. P... a 48-year-old man who was in good general health, reported to the service of Professor Verneuil at the Hospital Lariboisière. He noted the development of a large tumor on the left side of his face over the past 10 years. It started as a nut-sized movable lesion. It did not cause pain or hemorrhage nor impair his health. About 5 months prior, the tumor began to ulcerate. Two small purulent areas developed in the mass.
On examination, the tumor, a typical parotid gland “vegetation,” measured 42 cm in circumference at the base. The skin was “friable” in areas. No odor was evident. The tumor pushed the ear back, and the left side of the face was paralyzed, except for the upper eyelid.
At operation, an attempt was made to avoid hemorrhage by not using a scalpel but a galvanic cautery knife, special clamps, and hot iron cautery. The external carotid and other arteries were ligated with sutures and cauterized. A 2-cm wide margin was made at the base. The tumor was removed with little blood loss by using two clamps across the dissected base and then using the cautery knife and a large hot iron cautery. No trace of the tumor could be seen in the base after removal.
The wound was dressed and changed three times a day for 6 days. The temperature didn’t rise by ½ degree, which meant there was no “trauma fever.” The wound was dressed with a water and phenol solution gauze dressing daily. In the month of March, the patient left the hospital to recuperate at home. On June 29, the patient returned to the hospital, and the postoperative photograph was taken. The patient remained with left facial paralysis, but the upper lid functioned so well that the eye was covered.
In summation, Dr. Verneuil declared he had never operated on such a large tumor. He believed the tumor was not malignant because of the slow growth, so surgery was possible for a cure. He discussed the concept of a two-stage operation, with tying off the carotid arteries as a preliminary procedure. He emphasized his use of a galvanic knife, hot iron, and clamps, which resulted in a blood loss of only 200 g. Using his technique allowed slow careful dissection in a bloodless field, making only a single-stage operation necessary for removal of these tumors.
Dr. Verneuil’s surgical operative recommendations were ultimately elaborated upon and refined by America’s master surgeon William Halsted, MD. He emphasized that a dry field allowed slow, careful, thoughtful dissection in any operation and was especially important in cancer procedures because of the aberrant and aggressive vessel and tissue growth. ■
Excerpted from Oncology: Tumors & Treatment, A Photographic History, The Anesthesia Era 1845-1875 by Stanley B. Burns, MD, FACS. Photographs courtesy of Stanley B. Burns, MD, and The Burns Archive.