Jonathan Mason Warren's February 6th report.

CASE XV. On the same day that I operated on the malignant erectile tumor, No. 10, another person consulted me with a tumor in the substance of the right cheek, having some striking points of resemblance to the former case. He said, that it made its appearance ten years since, from which time it had gradually increased.

      When I saw him, the cheek on that side was much forced outward, and he informed me that at times it was one third larger than the other. With one finger applied on the inside of the mouth and the thumb externally, so as to embrace the whole substance placed between them, I distinguished a hard lobulated tumor, quite movable, situated below the zygomatic arch, and partially extending up under it. By the use of force it could be carried outward, so as to make a projection over the ramus of the lower jaw. During the examination I perceived something of a less resisting nature than the body of the tumor slip from under my fingers. After one or two trials, and taking into consideration the history of the case, the large projection on the cheek not accounted for by the tumor to be felt there, also its periods of increase and decrease, I came to the conclusion, that I had to do with a tumor pervaded by the erectile tissue.

      As the patient lived out of town, I advised him to enter the Hospital, where I operated upon him in February [6th, 1847]. Before the operation, a number of gentlemen, who examined this tumor, could not be convinced that it was other than an ordinary steatoma. The patient was put into a state of insensibility by inhaling ether for four minutes. The tumor was now made to project over the lower jaw, by forcing it from the inside of the mouth. The first incision laid bare the muscle; this being divided, a mass of varicose vessels, principally venous, projected through the wound; these, together with the body of the tumor, were dissected out, with some hæmorrhage. The operation was terminated by embracing with a ligature the base of this congeries of vessels.

      During the whole of this time the patient was insensible. When he revived he said that he had been on a long journey, and was surprised to find the operation terminated, and anxious to know if it had been thoroughly done. A severe attack of inflammation followed, which terminated by a large abscess in the cheek. This I did not regret, as it would probably be the means of destroying any of the erectile tissue which might remain. He left the Hospital well in a fortnight.

      The nucleus of the tumor in this case seemed to be composed of a fatty substance, quite firm before removal, but easily broken up by the fingers after it was dissected out. The mass of it was composed of erectile tissue.(73 »»)

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There is not enough information to declare this surgical event the one that was visually documented by EDD No. 1, but it cannot be ruled out because: 1.) Jonathan Mason Warren (Figure 8) is in the frame and positioned at the lead surgeon's station.   2.) The age of Warren's patient, registered as a 27-yr-old on Bigelow's table, approaches the age of the patient in the daguerreotype.   3.) The patient is positioned correctly for the surgery of a right facial tumor (reversed by the camera lens), although his head is turned in the wrong direction.   4.) There seems to be a swelling or prominence beneath the cheekbone of the patient.   5.) Morton is not in the frame, otherwise he would have been named.

On the other hand, the subject's beard isn't shaved in preparation for the surgery of a facial tumor, and the tumescence may be a distortion in the matrix of the daguerreotype, or simply a shadow play caused by the spotlights. Gould might have superintended the apparatus without Morton, but it is unlikely that Dalton was the etherizer for this surgery and more likely that Bigelow or Warren himself administered the ether. Furthermore, Warren doesn't comment on the physique of his patient in his report, which would have been warranted by the imposing figure seen in the "reenactment" daguerreotype. No other evidence was found to compel an attribution, other than the weight of its reprint in Dr. Warren's epitome of cases.(74 »»).

73.) Warren, JM (1847); p. 157-158.

74.) Warren, JM (1867); p. 534-535, "Case CCCXIX."

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