Journal : Photographic review of medicine & surgery ; vol. 2., no. 1.
Philadelphia : J. B. Lippincott & Co., 1871-72.
Description : p. 5-7,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Face — Epithelioma.
THE case before us, occurring in the service of Dr. F. F. Maury, Surgeon to the Philadelphia Hospital, is of such gravity that a few notes in connection with the photograph cannot fail to prove interesting.
Richard H. Parsons, aged forty, is a native of North Carolina, and a farmer by occupation. His family history presents no record of hereditary disease. He has always been a hearty man, and able to perform hard manual labor. He has never had venereal disease of any kind. About four years ago he noticed, for the first time, several nodules inside his nostrils, which gave him pain and caused annoyance. Some months later a nodule came on the outsfde of the right ala of the nose, upon which soon a scab formed, causing pain. At the end of a year from its first appearance, the disease still increasing, he became alarmed and applied for relief to a physician in Mississippi, who cauterized it with nitrate of silver as well as with stronger caustics, but without benefit. The disease continued spreading until the entire nose was involved. Arriving in Philadelphia last spring, he spent three months in the Pennsylvania Hospital, under the care of Dr. Hewson, where the earth treatment was tried. On admission to this hospital, in the latter part of July, he presented a truly horrible appearance. The nose was entirely gone, and the right superior maxillary bone eroded far back into the orbit, the body of the bone having disappeared. The tissue of both cheeks was being rapidly destroyed, and the ulceration extended up to the eyebrows. The eyes also were beginning to suffer. Below, the upper lip was almost gone, and the angles of the month were obliterated. The opening into the face was of such size that it was possible to look down upon the epiglottis. The edges of the ufcerations presented the hard everted character so characteristic of this form of disease. The tongue seemed partially loose from its attachments, and wagged to and fro against the sides of the cavity in a most distressing manner. Notwithstanding this deplorable condition, the patient was lively and cheerful, having very little pain, though formerly the process of ulceration was attended with severe pain. His appetite was quite good, and he rested well at night. Ere long, however, he commenced to complain of pain again, and his strength seemed rapidly to fail him. Stimulants and good diet were given, but the disease had gained its culminating point, and he began to sink, becoming more and more feeble day by day. At the opening of the autumn clinics of the hospital, he was presented to the class by Dr. Maury, the disease having by this time made even greater destruction than represented in the photograph. A few days after, he fell into a low condition and died.
Post-mortem examination of the affected part showed the entire superior maxillary bone wanting. The right nasal bone had been destroyed, and the vomer eroded. The ethmoid bone was also involved, and the basilar and right pterygoid processes of the sphenoid were considerably diseased. Both palatal bones had disappeared, and the petrous portion of the right temporal bone took part in the general destruction.
The picture tells its own tale, and shows the features so characteristic of this morbid process which runs its course with such ravages. The case, upon its admission to the Philadelphia Hospital, was beyond all hopes of recovery, and the treatment employed was such as to give the man as much ease and comfort as possible under the circumstances. That the process was one of epithelial degeneration there was no doubt, as microscopical examination showed the usual appearances of epithelioma in a marked degree.