NEW MEDICAL PUBLICATIONS IN GERMANY.

Abhandlung über die Durchbohrung des Bruftbeins: i. e. A Treatife on Trepanning the Sternum : by C. F. CLOSSIUS. From the Latin. With a fhort appendix, by I. G. KRAMER, 8vo. pp. 72. Marburg, Academical Shop.

Archiv für die Phyfiologie: i. e. The Phyfiological Magazine: by Dr. I. C. REIL, Prof. in Halle, vol. III. 8vo. pp. 530, and four plates. Halle, Curt..

Bibliothek für die Medicin, &c. The Library; devoted to Medicine, Surgery, and Midwifery. By a Society of literary men; edited by F. ARNEMAN, Prof. at Göttingen, Svo. vol. I. Göttin gen, Dietrich.

Handbuch für die Medicinifche Literatur, &c. A Compendium of Medical Literature, in all its branches; or, an Introduction to the knowledge of the moft valuable medical books, with their contents, prices, years of publication, and reviews; together with a variety of historical, biographical, and other remarks; fyftematically arranged. Attempted for the ufe of young phycians. By Dr. I. V. ROTHE, 8vo. pp. 664. pr. 2 rixd. 6 gr. or about 9s. 6d. in fheets. Leipzig, Kleefeld.

Anleitung zum Aufstopfen, &c. Inftructions for filling and preferving the coats of birds and mammillary animals. Derived from original principles and experimental rules, as well as thofe of expert Naturalifts. By G. PISTORIUS, (probably Becker) 8vo. 32 and 174 pp. Pr. 14 gr. or 2s. 6d. Darmstadt, Heyer.

Handbuch zur Kentnifs und Heilung, &c. A Manual of the Theory and Practice of the internal Diseases of the Human Body; compofed chiefly in confequence of original obfervations and experimental deductions made at the fick-bed. By Dr. I. C. STARK, Prof. &c. &c. 8vo. pp. 46 and 6681 with a well executed plate of the author. Pr. 2 rixd. 4 gr. or about 9s. Jena, Göpferdt.

To CORRESPONDENTS.

The unusual influx of original communications_this_month (fome of which we have been obliged to poftpone, as well as the account of feveral valuable medical books which we have received) occafions as ta defer the articles from the foreign Journals till our next publication.

We acknowledge the receipt of communications from Drs. Vaughan and Carfon; Meffrs. Peck, Shaw, Blackburn, Lipscomb, Brown, and Moore. We shall be much obliged to R. H. and A Navy Surgeon, for their Signatures or addrefs.

ERRATA.

Vol. III. p. 353 and 355, for Mr. Cranen, read Mr. Graven..

P. 450, 13, for June, read May.

P. 475, 1. 7, for five grains of calomel, read ten grains of calomel.

THE

Medical and Phyfical Journal.

VOL. III.]

JUNE, 1800.

[NO. XVI.

To the Editors of the Medical and Phyfical Journal.

GENTLEMEN,

IF
F the following paper be judged worthy of a place in your
very useful Journal, it is at your fervice. I am,
GENTLEMEN,

Bedford Row, May 9, 1800.

Your very humble fervant,
THO. WHATELY.

A Defcription of a new Inftrument for performing the
Operation for the Fiftula in Ano.

BY THOMAS WHATELY, Member of the Royal College of
By
Surgeons, in London.

SIMPLICITY of conftruction is certainly a great recommendation to all inftruments employed in furgical operations. We are not, however, to give the preference to any, merely on account of their fimplicity, as it may happen that the more complex may fometimes be better calculated to perform the operation in a proper manner; this is the cafe with Pott's inftruments for performing the operation for the radical cure of the hydrocele, which I know, from experience, anfwer better than the more fimple Seton lancet ufed by Mr. Hunter for the fame purpose.

The ingenuity of artifts has been frequently exercised in contriving an eligible inftrument for cutting for the fiftula in ano; an operation which confifts in dividing a portion of the rectum and of the adipofe membrane and the fphincter ani, fo as to lay open the finus or finufes which conftitute the difeafe. If thefe finufes are not completely laid open, or if the divifion be made in an improper place, the first operation fometimes fails of making a perfect cure. Any of the inftruments which have been made for this purpose, may answer the intention in particular cafes very well; but the blunt pointed NUMB. XVI. crooked

Sss

crooked biftoury, recommended by that excellent furgeon Mr. Pott, certainly has the pre-eminence, and when the operation is performed after the recent bursting of abfceffes in thefe parts, or where the external orifice is open enough to admit readily the paffage of the knife, there is perhaps no inftrument more eligible.

There are, however, many cafes of fiftula in ano, in which I think a better inftrument may be ufed. It frequently happens in those of long ftanding, (which oftener come under the operator's care than the more recent ones) that the external orifice is very small; fometimes fcarcely large enough to receive the point of a common probe. In fome of thefe cafes, the fiitulous cavity leading to the gut may be eafily traced by a probe. In others, either on account of fmall windings in the cavity, or from other obftructions which the probe meets with in exploring it, a little time is required in the examination, in order to afcertain the direction and extent of the finus; and whether it communicates with the cavity of the rectum by a direct opening through the gut, or runs on its outside only, without fuch a communication with its cavity. When the external orifice of the fiftula is very fmall, it will not be poffible in fome cafes, especially where a patient is timid, to pass the probe-pointed knife fo as to meet the finger, without its wounding more or lefs fome of the parts in its paffage. If the true direction of the finus be not followed after the introduction of the knife, it must be apparent to every one, that it cannot be explored without giving much unneceffary pain, by an inftrument that is liable to cut. And although it may not be difficult to push the inftrument within the cavity of the rectum, fo as to meet the operator's finger, yet it appears highly probable that this perforation may fometimes be made in a different part to that which was intended; an error which may occafion a failure in the cure. Sometimes we find the orifice of the fiftula fituated upon the buttocks, at the distance of three or four inches from the anus: In this cafe, the external finus must be in part opened by the knife, before the probe point of it can poffibly reach the operator's finger; and this may occafion fome difficulty in finding the true direction of the finus.

Thefe circumftances led me to adopt a new inftrument, which is the fubject of this paper. This inftrument confifts of a very narrow probe-pointed curved knife, with a ring affixed

This inftrument may likewife be made perfectly ftraight. In this form it will answer extremely well where the gut is to be fit not much above the -- Sphincter,