A child with a facial defect is presented using clinical details recorded in a ward journal of the Royal Infirmary of Edinburgh for 1853. The entry in the journal is illustrated by a clinical photograph and a pen and ink drawing. The operation for facial reconstruction is described together with an account of the post-operative course and outcome. The differential diagnoses and views on the aetiology of the patient’s disorder are considered. The photograph itself is described and the historical and social background of the patient are outlined.
