To the second remark, the above is also a sufficient reply; but we will add that it was recorded in the case book of the Pennsylvania Hospital in 1809.
Our comment on the third observation of Mr. Roche may be brief. It is that we promise an account of the case for the next number of this Journal. In the mean time, the patient was well known to us and to many persons now living. The operation was performed in 1809.
In reply to that portion of the last observation, which we have marked with italics, we can assure the reviewer that he is mistaken; at least with regard to this side of the ocean. We Americans are a very peculiar people, and but little affected, as yet, with the cacoethes scribendi; a malady which the present work, in its humble sphere, is designed to disseminate. We are not in the habit of frequently publishing, and above all, of publishing volumes. Books are dear, private libraries small, public ones few, and encouragement for even the best original publications but limited. Of this we have known some melancholy instances. It is impossible for either a Frenchman or an Englishman to judge correctly of a country, which, in many important respects, is in such a different situation from his own.
It is a thing of by no means uncommon occurrence here, to make a valuable discovery or improvement in the healing art, and not to make it public. A striking instance of this fact, at least with the exception of the insertion of an imperfect account in the Eclectic Repertory, which very probably never reached England, is mentioned in our last number. We allude to the extirpations of diseased ovaria, by Dr. M'Dowall, of Kentucky. Here a unique and brilliantly successful operation was performed, successful as yet beyond European imitations, and still the inventor and achiever of it did not possess vanity or industry sufficient to treat the public with a full account of it. M. Roche may find it hard to explain modesty of this species; but we can promise him, should these sheets ever reach his eye, and he still continue skeptical, abundance of proofs, and some more instances of the same kind.
42. Gangrenous Sore Mouth of Children.—Dr. Coates begs permission to add the following quotation from Fabricius Hildanus to the authorities quoted in his paper on gangrenous ulcer of the mouth, at the commencement of the present number.
"Gingivarum inflammatio maxime in infantibus in gangrænam interdum degenerat. Morbus enim magnus, vehemens et peracutus; magna quoque requirit remedia: sed quis illa in ore adhibere ausus?"—De Gangræna et Sphacelo, Cap. IV. p. 773. col. 2. Edit. Beyeri. Francofurt ad Mæn. 1646.
"Gangræna in partibus humidis, gingivis, palato, naribus, &c. raro sanabilis; in sphacelum autem degenerans, insanabilis."—Cap. XI. p. 781. col. 2.
This is all I find in that author, relative to the subject.
43. Operation for Phymosis.—M. J. Cloquet, has so improved this operation that no deformity results. He recommends the incision to be made at the inferior surface, near, and parallel to, the frænum præputii. The longitudinal wound thus made, becomes transverse, as soon as the prepuce is drawn behind the glans penis, and cicatrizes in a line scarcely visible; so that the prepuce acquires in breadth what it loses in length. M. Cloquet has, in this way, perfectly cured many patients; the prepuce appearing to possess its natural conformation.—La Propagateur des Sci. Med. for March.
44. Lunar Caustic on Wounds and Ulcers.—The practice of healing wounds and ulcers by natural or artificial scabs, to which the attention of the profession was first directed by Mr. J. Hunter, has been too much neglected, and the circumstances under which it is useful, have not been accurately stated. In a small work published by Mr. Higginbottom, in January last, at London, the practice of forming an eschar by the lunar caustic over small ulcers and recent wounds, has been strongly recommended as saving the patient much pain, trouble, and danger. The whole surface is to be pencilled with the solid caustic so as to form an eschar, and where this remains adherent, the wound or ulcer invariably heals with comparatively little inconvenience. When effusion occurs under the eschar, whether of serum or of pus, there is more difficulty; but if this fluid be evacuated by a puncture, and the caustic applied to the orifice, the eschar will often remain adherent. Sometimes the fluid must be frequently evacuated. If the eschar does not separate favourably, a cold poultice may be applied, which not only removes the eschar, but lessens the irritation and inflammation. Should the sore not be healed, Mr. H. recommends the reapplication of the caustic. To prevent effusion under the eschar, and to preserve it adhering, he advises the whole to be covered with a piece of gold-beater's skin; but we may add, that as this effusion arises from too much inflammation, more powerful means may occasionally be employed, especially a solution of acetate of lead. Larrey recommends with the same view, after the application of moxa, the use of the aq. ammoniæ. Indeed any evaporating, cold, astringent lotion will be advantageous.