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CASE
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THREE  REMARKABLE  TUMOURS
EXTIRPATED FROM THE NOSE.
           BY P. S. TOWNSEND, M. D.

                  OF NEW-YORK,

HONORARY MEMBER OF THE ROYAL JENNERIAN SOCIETY, LONDON, AND OF
      THE LONDON VACCINE INSTITUTION ; MEMBER OF THE
           MEDICAL SOCIETY OF NEW-YORK, ETC,
              COMMUNICATEJUST * LETTER TO


         DAVID HOSACK, M.D. F.R.S.

PROFESSOR IN THE UNIVERSITY OF THE STATE OF NEW-YORK, ETC. ETC,
        NEW-YORK:

PRINTED BY" J. SEYMOUR, 49 JOHN-STREET
1825. 
 
New-York, Nov. 19, 1825.
DEAR SIB,
     Mr. John Russel, aged 54 years, a planter, of
Abaco, one of the Bahama Islands, of robust short
stature, and of sanguine temperament, was attacked
in the year 1799 with small-pox, from which he re-
covered  after a severe illness.  His face remained
much pitted,  and the surface of the nose was parti-
cularly rough.  Soon after, there was a perceptible
enlargement of the teguments covering the  anterior
and lateral cartilages of the nose, which increased the
more rapidly, as he imagined,  from the practice of
squeezing out of the end and sides of the nose what
are vulgarly called worms, but which are well known
to be the secretion of sebaceous glands, indurated
and  blackened  externally by exposure to the air in
the orifices of their excretory ducts.
  Sir Astley  Cooper has  expressed an opinion that
encysted tumours may arise from obstruction in the
glandular follicles of the skin, and this may have been
the first cause of the disease.  It is not uncommon in
the more remote and unfrequented, or what are call-
ed  ott/-islands in the Bahamas, to meet with fatty
tumours  of small size  and globular shape, upon the
teguments of the forehead, nose, and cheek.  I have 
4
heard them attributed, with plausibility,  to the use
of salt fish and crude vegetable food.  Nothing how-
ever like the gigantic growth  of Russel's nose was
ever seen in the West-Indies, or any where described
in the annals of surgery.
  This patient came to consult me at Nassau, island of
New-Providence, about the middle of October 1824.
  For the last twenty years the nose had not varied
materially  from  the extraordinary  dimensions and
grotesque appearance which the sketch  presents in
Plate I.
  This enormous mass of disease consisted of three
lobular tumours,  having the appearance of a trilobate
pendulous excrescence from the nose.
  On examination I found them soft to the feel, and
not only pitting, but  exuding, on pressure, through
minute and almost imperceptible pores like those of a
carbuncle, a thin, glairy, yellowish pus. For years, he
informed me, he had been in the daily habit during
the warm weather, of squeezing out through  these
pores (which are doubtless the original orifices of the
diseased sebaceous follicles) a  tea-spoonful or more
of matter occasionally mixed with blood. They were
so moveable as to be easily turned up upon the fore-
head, so  as  to exhibit the openings into the nostrils
underneath, which in their natural position, hanging
down upon  the mouth, they entirely concealed. The
middle tumour extended  down as  far as the lower 
5
lip, upon which it rested, interfering very much with
drinking and eating, and also with articulation. This,
the largest of  the  three, was  about two inches in
breadth, and, measuring from the anterior to the pos-
terior surface,  an inch and a half in diameter: the
lowest part of it incurvated over the nostrils.   The
shape was spherical, as also that of the two lateral
tumours, which were more globate, and about one inch
in diameter. Each lateral tumour was seated upon the
external surface of the ala of the nose, leaving the rim
of the inferior part of the ala in its natural state, but
closely  adhering  to the cartilage  above this  by a
broad base nearly  co-extensive with the diameters
of the tumours. The middle lobe, however, involved
the whole of the tip of the nose, had a larger base and
attachment than the lateral lobes, and was more firm-
ly adherent than they to the cartilages upon which it
was situated.   The  middle  tumour  was  also entirely
separated on each side from the lateral tumours by a
deep fissure, leaving each tumour upon a distinct base.
These fissures had been made deeper, he said, by con-
stantly handling and wiping  out the clammy matter
secreted  between the  tumours.    The teguments
upon the diseased part were of the  same flushed co-
lour and rough  appearance  as  upon the rest of the
face.
  The remarkable  tumours upon  the  nose  of this
patient had been familiarly known for years through- 
6
out the Bahamas, as well as in many other parts of the
West-India islands; and so extraordinary and unique
were  they considered, that he  was in his  travels
every where proverbially designated by the cogno-
men of Big-Nose Russel.  The sneering and sarcastic
observations  many  persons  had  unfeelingly made
upon  his  misfortune, had for the last ten years, he
told me, almost prevented him from going abroad.
  There was no pain or irritability on handling the
diseased mass, but the weight of it at night  was so
unpleasant as to inconvenience his respiration, unless
lying on his back; in which posture, also, the nose
interfering with the mouth, would  cause him fre-
quently to spring from bed during sleep, with  a sense
of strangulation. The weight may be imagined from
the deep wrinkles upon the forehead and around the
eyes, occasioned by the incessant and powerful ac-
tion of the occipito-frontalis  and adjoining muscles,
in their effort to sustain the tumours.
  After having proposed the operation to the patient,
and with much difficulty  made him understand that
no  serious consequences were  to be apprehended
from it, he went home to Abaco, and in a few weeks
returned to Nassau, for the purpose of having it ac-
complished.
  In the meanwhile, the proposition I had made be-
came generally known; and  on his return to Nassau,
most of his friends,  and one or two practitioners of 
7
the place, secretly dissuaded him  from it,  and told
him that an operation of such moment rendered it
advisable that he should go to London, and consult
Sir Astley Cooper or Mr. Abernethy.
   These recommendations, the motives for which, in
several of his advisers, it was by no means difficult to
interpret, had the effect which was intended; so much
so that when, after  he had been at Nassau several
weeks, I again suggested the operation, he positively
and unequivocally declined. I had almost despaired
of again bringing his mind to the resolution of having
the deformity removed, until at length, on  Tuesday,
November 23d, 1824,1 succeeded in  gaining his en-
tire assent.  The operation was performed  about
noon of that day, in presence of Mr. Brydon, Assist-
ant Surgeon of the Forces at Nassau, in the following
manner: passing the scalpel first on the outer edge
of the left  lateral  tumour until  it  was  removed
smoothly from the cartilages to which it was attach-
ed, then doing the same with the right lateral tu-
mour, and  finishing  in the same  manner, with the
middle lobe; the whole operation being completed
in five minutes.   Several large compresses were then
placed over the nose across the face, secured by a
bandage round the head, to check the haemorrhage,
which was not more  than eight ounces.   Openings
were made through  the compresses  to admit light
to the eyes.  In four  days the dressings were  remov- 
8
ed, and in exactly two weeks from the moment of the
operation, the wound having (under the carbon, bark,
and alcohol poultice, and  tonics internally)  kindly
granulated by the first intention, the patient,  to the
astonishment of an assembled multitude, who throng-
ed after him, appeared  at the public vendue with a
smooth, handsomely formed nose.   The chagrin  which
this spectacle occasioned to those who had endea-
voured to defeat the operation, may  be  much more
easily imagined than described.
  On passing an incision  through the different tu-
mours, they were found to consist entirely of a dense,
homogeneous, adipose or  fatty substance of a white
colour, each containing  near  its centre one or more
small spherical  cysts of about a quarter of an inch  in
diameter, filled  with a thick, pappy, or atheromatous
fluid of a yellow colour.
  Plate II.  exhibits  the  appearance of the face and
nose after the cure.
                 Yours, respectfully,
                             P. S. TOWNSEND.
Dr. Hosack. 
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