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able time after the cicatrix had formed; until, indeed, those changes, which I have above described, had been fully accomplished. By such practice I conceived that the contraction, which I knew must follow so extensive a wound, would take place in a lateral direction, and not in the long axis of the limb. In a word, I hoped to be able to direct and modify that, which it was not in my power to prevent, and thus, at all events, counteract its injurious effect. Having submitted my opinion to some professional friends, which met their concurrence, on the 12th of November I performed the operation with the assistance of Mr. Lawrence, in the following manner. I made an incision on the outer side of the cicatrix, commencing about two inches above the elbow, where it was broadest, and terminating within two inches of the wrist; nearly the whole of this incision was made through the sound integuments. I then made a similar cut on the inner side, and carried it down gradually, converging until it met the opposite incision. The upper part of this incision was necessarily made through the cicatrix, which nearly enveloped the inner side of the elbow. The next step was to dissect off the firm horny cicatrix, which I detached from below upwards as high as the commencement of the incision, conceiving that this triangular flap of cicatrix might be useful in accelerating the healing of so extensive a wound. I did not remove it from its upper broad basis, thinking that it might unite in its new situation. On attempting now to extend the arm, we found considerable resistance from the forcible contraction of the flexor muscles, which had been so long accustomed to a more limited sphere of action, that they with difficulty admitted of any extension. By degrees, however, they yielded considerably, and the arm was brought nearly to a right line. When the arm was so extended, the extreme point of the cicatrix, which still remained attached to the upper arm, was deficient nearly three inches of reaching the part from whence it had been removed.
The sides of the wound were now approximated as much as possible with adhesive plaister, and the whole limb was bound down on a splint. As the operation had been rather tedious and very painful, and there was great disposition to spasm in the biceps, I gave him a large dose of opium, and
directed the nurse to sit by him and hold his hand, which checked the violence of the cramps. This disposition in the muscles to contract gradually abated, and the following day I was able to extend the arm perfectly to a right line. On removing the dressings, four days after, I found that the whole of the cicatrix which I had detached, had sloughed; in consequence, I suppose, of its being a part of new formation, and not possessing the same vital powers with an originally formed part. The slough was soon thrown off, and the wound, though extensive, wore a healthy aspect.
Nothing sinister occurred during the progress of the cure, and the whole was perfectly healed by the 20th of December. I continued to apply the splint constantly for about six weeks longer, during which time the cicatrix diminished much in a lateral direction, and in a very slight degree in the long direction, but the arm continued perfectly straight. I now permitted him to use his arm for some hours during the day, but re-applied the splint when in school and at night. By degrees he left off the use of the splint altogether during the day, but I directed it to be applied at bed-time until about a week since. I am happy to add, that nearly five months have now elapsed since the wound was healed, and his arm continues perfectly straight, and he enjoys the free use of it as much as the other. The cicatrix has contracted laterally to about one-third the size of the wound, is quite insensible, hard and devoid of vessels, and on the whole, from its present appearance, I do not apprehend that any further alteration will take place.
I have considered this case not unworthy of attention, as it strongly illustrates the efficacy of art, well directed, in counteracting and even rendering subservient a powerful law in the animal economy. The view which I have been led to take of the subject is, I believe, new, and the result of the case will, perhaps, warrant my expectations that it may be beneficial both in the prevention and cure of many deformities and contractions in the extremities.
Should a similar case occur to me again, I should prefer the removal of the whole cicatrix at once, to leaving it with the probability of its sloughing.
Report on the Epidemic Small Pox and Chicken Pox, which
prevailed in New York during the last Autumn and Winter, explanatory of the Causes of supposed Failures of the Vaccine Disease. Ordered by the Medical Society of the City and County of New York, at their quarterly meeting, January, 1816. [The re-appearance of Small Pox in the City of New York during the last year, has excited the attention of the Medical Society; the report of whose committee may be considered as a valuable document on this interesting subject. They have designated the origin of the disease, its character and mortality, and have expressed their opinion on the efficiency of Vaccination, and of the sentiments entertained with respect to its preservative power. They also give an account of the appearance of Varicella, with the unusual severity of its symptoms.
We make an abridgment of this publication, which is well worthy of pub. lic notice, and hope it may excite similar attention in other parts of our country, where epidemics shall appear in uncommon forms.]
To the Medical Society of the City and County of New-York. The Committee appointed to examine into the progress of the
Small Pox for the year past in this city: to ascertain the origin of reports which have arisen unfriendly to the Vaccine Inocula.
tion, and to enquire into any supposed failure of the Kine Pock: RESPECTFULLY REPORT:
That they have diligently endeavoured to ascertain the origin of the small pox. The first fatal case of that disease was found reported at the Inspector's Office on the 15th May, 1815. It occurred in the person of a soldier of the name of Asa Tanner, who had been for a long time in a Military Hospital on account of frosted feet, from which he had not recovered when he arrived in this city, in a coasting vessel from Boston. He lodged in a common boarding house in the lower end of Front-street, and was taken sick immediately after his arrival: it was a case of confluent small pox, which terminated his life in five days. No person was discovered to have taken the Small Pox from this man excepting another soldier and fellow-lodger in the same house, who, it is believed, died in the Military Hospital at New Utrecht, on Long-Island.
No other fatal case of this disease is found recorded until
the 28th of August. Another death occurred on the 30th of the same month, more than three months after the first recorded death by the small pox.
Your committee are informed by A. Smith, a soldier, that the small pox existed on Governor's Island in February, 1815. He particularly mentioned a girl of the name of Munson, the daughter of a soldier, who had the small pox about that time. She was attended in the hospital by the military surgeon, and recovered.
In the early part of October, the small pox appeared in various parts of the city, and further inquiry into succeeding cases of it was deemed unnecessary.
Your committee not having been able to procure any public or private records of the cases of small pox, except of those which were fatal, regret that it has not been in their
power to trace more explicitly the introduction of that disease into our city.
Your committee, however, are inclined to think, that it was introduced from some distant place by means of trading or coasting vessels: this opinion is derived from the consideration of the two first recorded deaths, and of the second case of the disease; or, that it has been conveyed into the city through the military, with which our intercourse has been more extended and multiplied during the continuance of the late war, than any other district of the union. The early appearance of the small pox in the military hospital of Governor's Island, and the fatal termination of the complaint in three soldiers at the commencement of the epidemic, have already been mentioned.
In the course of the month of November, the United States' frigate Guerriere arrived in this port from the Mediterranean, with many of the crew labouring under the small pox; seventeen cases of that disease were carried to the hospital at the Wallabout.
Your committee have to offer a few remarks in relation to the character and mortality of the small pox, as it has appeared in our city. As an epidemic, generally speaking, it has been so virulent in its nature, as to attack almost every
individual in whom the susceptibility to its action had not been destroyed VOL. VI.
by inoculation or vaccination. The duration of the disease was generally short, the progress of it very rapid, and the treatment, comparatively speaking, but rarely successful. In the the majority of instances it was confluent: adults appear to have been as subject to it as children. It prevailed most among the poorer classes of the community, and more in the eastern and upper parts of the city, than near the North River, and in the larger streets on the west side of Broadway. The proportion of deaths, from this confluent small pox, has been greater, in the opinion of your committee, than has ever been observed in London, or on the continent of Europe. The number of deaths, recorded in the Inspector's Office, amounts to two hundred and fifty-four; and thirty-nine deaths are reported to have occurred at the Lazaretto. This number, in the opinion of your committee, is somewhat more than one third of the aggregate cases of the confluent small pox that have occurred in the city. But supposing the aggregate of such cases of the small pox to be only eight hundred; and admitting an addition of one third of this number to have taken the small pox in a mild way, or of the distinct kind, it will give a total of nearly eleven hundred cases of the small pox that have occurred in this city and its suburbs, from the period of the first reported death, to the 1st of April, instant; exclusive of a very large proportion of persons that have received the disease by inoculation, and of whom no precise or definite estimate can be made, for the want of the necessary records.
The varicella, or chicken pox, another eruptive and febrile disease, appeared about the same time with the small pox, and prevailed generally throughout the city and its suburbs. It was marked by severe and unusual symptoms, and presented the appearances in particular cases, that have been said to belong to swine pox, or water pox, authorising the conclusion of their being varieties of the same disease. *
It has been observed, that “medical assistance being seldom necessary in the chicken pox, practitioners are less acquainted with this than most other eruptive fevers.”+ The committee here advert to the opinion of such high authority on this sub
* Thomas's Modern Practice.
† Wilson on Febrile Diseases.