Child, standing, with a tumor over her right eye. First Report Quarterly Report, from the 4th of November, 1835 to the Fourth of February 1836, Chinese Repository 1835-36, Vol. 4, p. 467-469: “Sarcomatous tumor. Akae, a little girl, aged 13. As I was closing the business of the day, I observed a Chinese timidly advancing into the hospital leading his little daughter, who, at first sight, appeared to have two heads. A sarcomatous tumor projecting from her right temple and extending down to the cheek as low as her mouth sadly disfigured her face. It overhung the right eye, and so depressed the lid as to exclude light. The parotid and also its accessory gland were very much enlarged. This large tumor was surrounded by several small and well-defined ones, the principal of which lay over the buccinators muscle. Slight prominences on other parts of the body indicated a predisposition to tumors, which I have learned, is hereditary. The mother presents a most singular appearance, being covered from birth with small tumors, some of the size of large warts, and others hanging pendent, in shape and size like the finger. Akae is the only one of her four children thus afflicted. Her general health was somewhat deranged, the tongue foul, pulse frequent and feeble, and the heat of the tumor above the natural temperature of the system. The blood vessels passing over it were much enlarged. The weight much accelerated its growth, and occasioned pain at night in the integuments around its base. The child complained of vertigo, and habitually inclined her head to the left side. According to the statement of parents, the tumor was excited into action by the small-pox, which the child had four years since, but within the last four months had attained three fourths of its present magnitude. The child was put under medical treatment for a month, during which her health decidedly improved. From the first, it appeared to me possible to remove it, yet the possibility of an unfortunate result, or even of the child’s “dying under the knife”, and the operation of the hospital being thereby interrupted or broken up, did not escape any thoughts. On the other hand, however, it was a case presented in divine providence, and it was evident that, left to itself, the tumor might terminate the life of the child, and that, from the accompanying symptoms, before a great length of time. The surgical gentlemen whose counsel I was so happy as to enjoy were all agreed as to the expediency of its removal, yet with all its circumstances, they regarded it a formidable case. Though in a Christian and enlightened land the surgeon might have undertaken it without embarrassment, it was not so here. Having often, in secret as well as in concert with others, commended the child to the great Physician, I resolved upon the undertaking, with the precaution of procuring a written instrument, signed by both parents, stating that the operation was undertaken at their desire, and that they would exculpate me from censure of the child should die in consequence of the attempt. Even the burial of the corpse was a subject of forethought and agreement with the father. On the nineteen of January, with the signal blessing of God, the operation was performed. The serenity of the sky after several days of continued rain, the presence and kind assistance several surgical gentlemen, and the fortitude of a heroine, with which the child endured the operation, call for my most heartfelt gratitude to the Giver of all mercies. A few days previous to the extirpation an evaporating lotion was applied to the tumor. An opiate was given fifteen minutes before, and wine water during the operation. The patient cheerfully submitted to be blindfolded and to have her hands and feet confined. The extirpation was affected in eight minutes. Another small tumor of the size of a filbert was also removed from under the eyebrow. The loss of blood was estimated to be about ten or twelve ounces. Not an artery required to be taken up. She vomited, but did not faint. The tumor weighed one pound and a quarter. The circumference at its base was sixteen inches and three quarters, and the length of the incision from the top to the head to the cheek ten inches. On opening it I found portions of it becoming black and two or three drachms of sanious blood of a dark chocolate color, indicating that it had already taken on a diseased action. After a nap the child awoke cheerful as usual; in the evening her pulse was accelerated and she complained of nausea, but ever afterwards uniformly said that she had no pain. No inflammation supervened, and the wound healed by the first intention. Three days after the operation, in several places of an inch or more in length, it had completely healed, and it fourteen days the whole, except a spot the fourth of an inch, was entirely healed. In eighteen days the patient was discharged.” Continuation of the case in the Third Quarterly Report for the term ending on the 4th of August 1836, The Chinese Repository 1836-1837, Vol. 5, p. 188: “Akae is mentioned in the first report under date of December 27th, 1835. About three months subsequent to the removal of the original tumor, as she was walking by the river side, a coolie, carelessly passing by, thrust the end of the bamboo, with which he carried his burden, against the superciliary ridge of the right temples from which the tumor had been removed. When she came to the hospital a month after the accident, there was considerable tumefaction above the eye. It being the close of that term, she was directed to remain at home until the first of June; at which time the tumor had attained the magnitude of the former one though not exactly the same shape and others previously on the side of her face were enlarged. The new one was altogether of a different character from the former. It had the appearance of a spongy mass, (…) the general health was affected and death seemed probable and that speedily, unless its progress could be arrested by a surgical operation, while the heat of midsummer not a little increased the hazard of such a measure. (…) On the first of July the operation was performed. On the first incision being made a large quantity of greenish fluid gushed out from cells of disorganized matter. The tumors above the ear were all removed (…) There was a loss of sixteen ounces of blood. (…) The constitution suffered much more than in the former instance, but she has very much regained her strength and the flesh she had lost, and now looks forward to the prospect of returning home in a few days, with the hope of enjoying a happy reprieve from the grave. Case Summary from Peter Parker's Journal: "I observed a Chinese [man] advance timidly to the hospital leading his little daughter, who at first sight appeared to have two heads. A sarcoma hung over the right eye and so depressed the lid as to exclude the light. The child complained of vertigo, and habitually inclined her head to the left side. It was evident that left to itself the tumor might terminate the life of the child." As a precaution, Dr. Parker had both parents sign a statement which read "they would exculpate me from censure, if the child should die in consequence of the attempt. An opiate was given 15 minutes before, and wine and water during the operation. The patient cheerfully submitted to be blindfolded and to have her hands and feet confined. The tumor was extirpated in 8 minutes."
Medicine, Chinese Missions and Missionaries Missions, Medical Neoplasms Tumors
Akae Case No. 446 Parker, Peter, 1804-1888
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