The case of Robert Penman’s tumour

The preoperative portrait of Robert Penman

At the age of 16, Robert Penman presented to a local surgeon with an egg sized tumour in his lower jaw. The connecting teeth were excised, nevertheless, over time, the growth grew rapidly and was later “cut off from the bone” at The Royal Infirmary of Edinburgh. However, the tumour continued to grow and the wound would not heal.   The growth continued to develop over the next two years. At this time a distressed Penman consulted Robert Liston, who did not recommend treatment. Three and a half years later, when Penman was 24 years old, James Syme was approached to assess and operate on Robert Penman’s tumour.

A cast of Robert Penman's Tumour

In 1828, Syme removed a 72oz fibro-osseous tumour from Penman. The procedure was carried out without anaesthesia in 24 minutes, while Penman sat upright in a chair. The Penman operation is a significant example of Syme’s extraordinary skill as a surgical pioneer. The case was well documented by Syme and also represented by two engravings by John Lizars. The tumour, a preoperative portrait, postoperative photo and two preoperative casts are held in the Museum collections.

The tumour of Robert Penman (with teeth visible at the left handside)

By reinterpreting the narrative and artefacts relating to this case, we can not only demonstrate the surgical excellence of Syme, but can also highlight the suffering and bravery of patients before anesthesia. This operation required courage and compliance from the patient, despite the agonising circumstances. Syme’s notes on the operation stress ‘all this time was not employed in cutting, as I frequently allowed a little respite, to prevent exhaustion from continued suffering. The patient bore it well, and did not lose more than seven or eight ounces of blood’. Syme and Penman met by chance 17 years after the operation. Penman had grown a large beard to disguise the scarring, and Syme reported he was ‘no less surprised than pleased to see how little the operation had injured either his appearance or articulation’. The tumour, casts, portrait and notes were used by Mr. Iain Macintyre, FRCSEd to tell the story of Syme and Penman during the Museum’s Science Festival events in 2013.

Robert Penman in later life

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