402 Diseases of Bone. 



B. Upper Jaw akd Facial Bones. 



6. 490. Fibroma of the Upper Jaw. — Wax cast of an enornaous 

 tumoiir of the upper jaw of a woman, successfully removed by- 

 Mr Robert Liston. 



"Mrs Fraser, aged 40, from Banchory-Ternan, Aberdeenshire, 

 was admitted into the Royal Infirmary of Edinburgh on the 13th of 

 October ISSl, under the care of Mr Liston. 



"About six years ago she received a blow over the antrum, from 

 the head of a child, immediately after which she perceived a slight hard- 

 ness in the jiart which had been struck. This did not increase for some 

 time after, but at the end of two j'ears a distinct tumour was felt on the 

 cheek. It grew very rapidly during the two following years. At this 

 time she became pregnant, when, she says, it increased very much, 

 especially after the quickening of the child. She had never suflered 

 very much pain in it. About a year ago she had another child, since 

 which time the catamenia have never appeared. The tumour seemed to 

 her to grow more vascular after she had passed the menstrual period, and 

 since then bleeding to a slight extent has occurred from the unbroken 

 surface of the gums and inner surface of the tumour at these times when 

 she should have been unwell. 



" On her admission the tumour presented the following appearance : 

 — The left side of the face is completely occupied by an immense growth, 

 which obstructs the eye of that side, rising to a level with the forehead, 

 extending back to the ear, and bulging down below the inferior maxilla, but 

 not attached to it. From the part of the tumour next to the ear to that 

 part in front of the face, it measures about nine inches. The mouth is 

 completely drawn to the left side, and there is a constant discharge of 

 -saliva from it. She keeps a handkerchief constantly applied to it by the 

 hand, to concentrate the sound of her voice when speaking, and to collect 

 the saliva. She is unable to open her mouth above three-fourths of an 

 inch. The tumour bulges considerably into the cavity of the mouth, but 

 there is no difficulty of swallowing. The nose is also twisted to the left 

 side, but she can breathe through it pretty easily. From these distortions 

 the face has a truly frightful appearance. Numerous large veins are seen 

 beneath the integuments of the tumour, and arteries of considerable size 

 are felt beating in it. Her general health is good, and she has firmly 

 made up her mind to undergo the operation for removal of the tumour, on 

 account of its inconvenience and unsightliness." (From "Observations 

 on some Tumours of the Mouth and Jaw," by Robert Liston, Esq., in the 

 20th vol., 1837, of the Mcdico-Chirurglcul Transactions, London.) 



About two years afterwards the following note was given by the 

 patient's local medical attendant, and is appended to Mr Listen's observa- 

 tions previously quoted from. "Having seen the mother of the lady 

 with the gold palate yesterday, I am enabled to assure you that she 

 continues perfectly well. She finds ISTasniyth's apparatus answer admir- 



