A man (Woo Kinshing), facing front, with a massive tumour on the left side of his trunk. Gouache, 18--, after Lam Qua, 1837.

Described in Peter Parker's notebook, case No. 5111, 11 April 1838: 'Woo Kinshing, aged 49, a fisherman from Shihszetow, near the Bogue, ten years since had a small tumor just below the clavicle on the left side. It had now attained a very great magnitude resembling in figure a tenor viol. Superiorly it extended over the shoulder to the spine of the scapula and from the acromion process [outer upper point of the shoulder blade] to the trachea, and from the axilla to the sternum, and as low as the breast, carrying that galnd down before it. The circumference at the base was three feet three inches! Its perpendicular length was two feet, and its transverse diameter from axilla to the sternum one foot eight inches. It was very vascular, especially the upper portion of it, which was in an inflamed and ulcerated state. ... There was a deep longitudinal fissure, and ulcers at several points, from which there was a constant discharge, of blood, lymph, and pus. The weight of it had become extremely burdensome, and several times a day the patient experienced severe paroxisms of pain, causing him to groan aloud, at which times he laid his tumor upon the floor and reclined himself upon it. In this position he spent the principal part of his time day and night. His countenance and furrowed brow expressed unequivocally the calamity he had suffered. His friends were much delighted on being told that it probably could be removed with safety, but the old man had been too long accustomed to expressions of suffering to yield to those of joy, and in his feeble condition was less sanguine probably in the feasibility of separating him from his old companion. He desired to return to his family for a few days previous to residing in the hospital; he was prescribed for and went home. On the 23rd of April he returned. Having undergone half a month's preparatory treatment, on the 22nd of May, assisted, as ususual in cases of magnitude, by Messrs. Cox and Jardine, and several other friends the operation was performed. Thirty drops of laudanum were given the patient hald an hour previously, and after placing himself upon the table, the tumor was elevated for eight or ten minutes to return its blood to the system as much as practicable. As the surface was extensive and the veins large and numerous, it was deemed best not to make the incisions the whole length at first, and the result confirmed the judicisousness of the measure. Two incisions were first made from the breast upwards as high as the clavicle or a little above. The gush of venous-blood was considerable, and the first steps less encouraging than was anticipated ... the dissection was almost as difficult as that of the skin on the bottom of the foot. Perceiving this, the operation appeared most formidable, and the result scarcely doubtful, but it was too late to retrace our steps. ...it required division by knife at nearly every inch of surface throughout its base, and the clavicle attachment was particularly strong. The tumor was extirpated from below to a little distance above the clavicle, when the patient began to faint and to be convulsed, and his pulse was scarcely perceptible. Stimulants, brandy and spirits of ammonia, were administered by assistants and the operation continued. He soon revived and the tumor was immediately laid upon the floor, being just sixteen minutes from the commencement, and not a ligature was required. ...It weighed 15 pounds avoirdupois, and it was estimated by the best judges present that there was a loss of about two pounds of blood. ... The first ten days he lost a good deal of flesh, but since then the scale has turned in his favor. In twenty days all below the clavicle was firmly healed, and the large cavity above was most rapidly filling up with granulations. No fever supervened upon the operation. On the 19th of June the old gentleman was discharged in perfect health, forming a great contrast with his former emaciated appearance."--Rachman, loc. cit.