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The first question which Dr. Palasciano attempts to solveis the following-What agents are concerned in the move-ment of rotation of the leg? The Wengels consider the bicepsas the external rotator muscle, and the popliteus, Sartorius,gracilis, and semi-tendinosus, as the internal rotator muscles.Dr. Palasciano thinks that the tensor vaginae femoris is amuscle especially destined to the mctvement of rotation out-wards. This muscle, called by Chaussier the ileo-aponeiro-tique, is attached, superiorly, to the crista of the ilium, andis continued, inferiorly, into the fascia of the thigh; but fibresare continued downwards, under the outer part of the fascia,to the external tuberosity of the tibia, where they are in-

serted. These fibres, of which the existence has been longknown, form a long tendon to the tensor vaginae femoris,which, by these means, may become a rotator of the leg out-wards. Let any one place the hand over the tensor vaginaefemoris muscle in his own person, and upon rotating the legoutwards, he will feel the muscle swell, and the outer part ofthe fascia become tense.Dr. Palasciano next replies to the question=Why is the

inner part of the thigh, where the muscles are numerous andstrong, covered by so thin a layer of fascia, and unprovidedwith a tensor muscle ? " The muscle contained in the outer

part of the fascia lotu," says he, "is not for the purpose ofstrengthening the fascia; its function is quite different: it isa rotator of the leg outwards. In the state of extension ofthe knee, supination of the leg is impossible; no muscle wouldtend to produce it in this position; the tensor vaginae femorisand the biceps are both powerless; but as soon as the legbecomes flexed, both muscles are so arranged as to cause itsrotation.In an immense majority of cases of displacement of the leg,

as a consequence of disease of the knee, the tibia is dislocatedbackwards and outwards ; the leg is somewhat flexed, ab-ducted, and rotated outwards; the patella is displaced uponthe outer condyle of the femur. The flexion of the leg isbest encountered by Dieffenbach’s plan, of first violentlyflexing the leg, by which adhesions between the tibia, femur,and patella, are broken; the limb is subsequently extendedby instruments. Supination of the leg, when not remediableby bandage, is to be overcome by the subcutaneous divisionof the tendon of the biceps, and of the external rotatormuscle of the leg, (the tensor vaginae femoris.) The influenceof the tensor vaginse femoris muscle upon the rotation of theleg was illustrated experimentally by Dr. Palasciano, in thepresence of Drs. Bouchacourt and Bonnet.When the patella is drawn outwards, it becomes firmly

pressed against the outer condyle of the femur; the opposedsurfaces ulcerate, and osseous union speedily ensues. Previousto the- forcible flexion of the leg, as adopted by Dieffenbach,Dr. Palasciano recommends the subcutaneous section of the

quadriceps extensor cruris, by which means the patella,liberated from its confinement upon the condyle of the femur,yields more readily to any force acting upon the ligamentumpatell.

Foreign Department.ACADEMY OF SCIENCES.

Typhoid 1’ever one of the Exanthe1nata>’ Treatment of this Feverby the Black Sulphuret of Mercury or Ethiops’ Mineral.

THE following paper was read at the seance of the Academyof Aug. 2, by M. SERRES, in which that physician endeavouredto show that typhoid fever should rightly be looked upon asone of the exanthemata, and that it has peculiar relations tosmall-pox. M. Serres began by stating that typhoid fever isbecoming more and more frequent in France, and that thisalone would claim attention to it. He then stated that typhoidor entero-mesenteric fever has always appeared to him, andalso to M. Petit, in its symptoms, course, and anatomical lesions,to belong to the exanthematous fevers; and went on to saythat-"1. Every eruptive fever, like typhoid fever, consists essen-

tially of two distinct elements-first, of the exanthema or

eruption, which constitutes its basis; secondly, of the group ofphenomena which this eruption develops in the organism, andbrings along with it. This group of phenomena, known by thegeneric name of fever, constitutes the form or character ofthese maladies.

2. From the relations which exist between the eruption andthe fever-that is to sy, between the basis and the form ofthe malady, are derived the fundamental conditions of erup-tive fevers.

3. The principal of these conditions resides in the propor-tional relation which is remarked, on the one hand, betweenthe intensity of the exanthema, and, on the other, the corre-lative intensity of the febrile phenomena.

4. If the exanthema is discrete or but slight, the fever isalso slight; if, on the contrary, the exanthema is confluent,the fever is very intense; it becomes, so to speak, confluentalso by the alteration undergone in the composition of theblood, and in the phenomena of reaction which are developedin the system generally.

5. The history of measles, scarlatina, erysipelas, but particu-larly that of small-pox and of cow-pox, has established almostpositive evidence of the existence of pathological relations.These relations were in our mind, when, in 1812, with M. Petit,we established a connexion between entero-mesenteric feverand variola. At that period we observed, We are thereforeable to look upon it as demonstrated by facts, that the altera-tion of the intestine and mesentery precedes and accompanies,in its development, typhoid fever, and that the severity anddanger of this fever are always proportionate to the intensityof the abdominal affection."

6. Since that period-that is, for thirty-five years-constantexperience at the Hopital de la Pitié, and post-mortem exa-minations at the School of Anatomy which receives the deadbodies from all the hospitals of Paris, have given to this pri-inary proposition all the certainty requisite in medicine.

7. At the bed of the sick, and on the subject, we have madeevident that there exists a discrete form of typhoid fever, likeas there is a discrete variety of small-pox; also a confluententero-mesenteric fever; and again, a third semi-confluentform, just as there exists a confluent and a semi-confluent formof variola.

8. Moreover (and this is a relation having immediate refer-ence to therapeutics) an attentive comparison of the febrilephenomena with the intestinal eruption has demonstrated aconstant proportional relation to be also present between theintensity of the eruption on the one hand, and the intensity ofthe general symptoms of the disease on the other.

9. Whence it follows, that with respect to the basis as wellas to the form, typhoid fever presents over again the form andthe basis of variola, the two maladies differing only in nature.

10. From these notions the foundation for the treatment oftyphoid fever is derivable.

11. If, as we have just seen, every eruptive fever consists of £two distinct elements-of the eruption, which is the over-

ruling element, and of the fever, which is the subordinateelement, the therapeutic tendency of these maladies is foundmarked out by the very subordination of their phenomena.Reason indicates it; experience has demonstrated it.

12. We shall take variola throughout, in order to draw acomparison.

13. Sydenham thus expresses himself:" It is proper to

observe, and it is a constant thing, according to the best obser-vations, that the fewer pustules there are in small-pox, theless dangerous is it; and the greater their number, so does thedanger increase. Thus the small or large number of pustulesdecides the life or death of patients."

14. " It is easy," adds Sydenham, " to explain why, in variola,patients are in so much the less danger the less numerous thepustules are; for each of them is at first a little boil, whichvery soon becomes an abscess; and it consequently happens,that the secondary fever produced by the suppuration is moreor less violent in proportion to the quantity of pus formed."

15. " One will not be surprised that the great number of pus-tules causes so much danger to the patient, if he will reflecton what happens as the consequence of a boil seated on anypart of the body; for this tumour, proceeding to suppurate,does not fail to excite fever by means of the particles of pus,which, being introduced into the veins, according to the lawsof the circulation, cause a tumultuous movement in the blood.’* z

16. In this so faithful a sketch of the course and the originof the symptoms of variola, we recognise that of typhoid feverwhich we may sum up in the words of M. Petit—" There is,we may say, something more than a local affection; the causewhatever it be, which acts on the intestine, is certainly of

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poisonous nature, for we find the structure of the mucous mem-brane always greatly altered, and often, indeed, completelydestroyed. Moreover, a like agent, transmitted by absorptionto the mesenteric glands, must bring about in them some gravechange; therefore we find its passage through them markedby the state of disorganization they offer.... Lastly, thissame principle, disseminated by an ulterior absorption through-out the system, can but produce those marked and severeeffects.... Thus is explained that series of general symp-toms, so imposing collectively, and so frequently fatal in theirresult."

17. If, in fact, in comparing these two maladies, (small-poxand typhoid fever,) the basis, or, in other words, the eruption,peculiar to each, we discover a perfect similarity in the phe-nomena of the secondary fever which constitutes them,-thesame infection of the blood, the same permanence in thesource of this affection, the, same saturation of the systemwith a poisonous principle. The foundation for their treat-ment should, then, also partake of and reflect in some measurethis conformity.

18. But in order for this to happen, we must found ourtreatment on the basis itself of these two diseases. But herearises the difficulty.

19. As regards variola, its etiology is not a matter of dis-

pute ; it is evident, and acknowledged on all hands, that be-sides the cutaneous affection, there is also a general onecoming from the state of the blood.

20. But it is not so with the etiolegy of entero-mesentericfever. Some have looked upon this fever as only a kind ofenteritis, the different degrees of which would explain thelocal and general symptoms.

22. It is too much overlooked, that in eruptive fevers thefixed element of the disease is the eruption, whilst the feveris its variable element. This omission has exerted very in-jurious effects on the knowledge of typhoid fever.

23. In fact, the adynamic form of typhoid fever being modi-fied, Broussais, who practised among young soldiers, did notsee the true elements of the disease. Pinel had describedtyphoid fever as enteritis; Broussais included it in a class ofmaladies he called gastro-enteritis. Bretonneau described itas dothinenteria; MM. Lherminier and Andral, as an intes-tinal exanthema, &c.

25. This being laid down, I will give an account of thetreatment I have pursued for three years in this disease.

26. This treatment consists in the administration of mer-cury internally and externally: in the form of Ethiops’mineral-the black sulphuret of mercury-internally, as pills;externally, as a mercurial ointment, applied by friction overthe abdomen. From two drachms to two drachms and a halfof the ointment are rubbed-in every morning. The pills ofthe sulphuret are generally prescribed every other day, fouror six in number, and made according to the following for-mula:-Ethiops’ mineral, fifteen grains and a half; gum traga-canth, ten grains; simple syrup, sufficient to make a mass.To be divided into four pills.

27. The treatment here pointed out may be persevered infor eight or ten days, without interruption, before any sign ofsalivation makes its appearance. When the gums begin tobe affected, the frictions are at once suspended, and the mer-cury of the pills is diminished one half, if it be still necessaryto continue it; and alum gargles are prescribed for the mouth,and lemon, in slices, to the gums.

28. This treatment merits serious attention,for two reasons.Up to the present time no one has thought or attempted totreat the intestinal eruption which attends typhoid fever, byany topical application; and yet there is no one who does notrecognise that upon its presence, upon its greater or less con-fluence, depends, in a considerable degree, perhaps entirely,the extreme danger of this disease. We are, then, allowed Ito hope that we shall diminish greatly the serious conse- I

quences of entero-mesenteric fever, by treating the intestinaleruption, and so putting the patient out of danger from ul-ceration, patches, and disorders of the digestive tube, that theeruption induces directly, or in the way of reaction. Purgativesin general perfectly fulfil the first indication, the treatment ofthe general poisoned state of the organism; but in order tofulfil the second, it is not a matter of indifference which pur-gative we employ. Mercurial purgatives alone possess aspecial topical action on the eruption in the intestinal patches,and amon them the black sulphuret of mercury, or Ethiops’mineral, does so in a particular degree. We are not able tooffer any direct proofs of the action of this mercurial salt onthe intestinal patches, since it is not obvious to our sight; butwe may arrive at a proof of its action by induction, à posteriori,by showing, first, what is the action of mercurial preparations

upon eruptions which attend diseases analogous to entero-mesenteric fever, and on the cutaneous eruption itself of thisaffection, and by then noting with care the symptoms whichfollow the internal administration of the medicine.Now, the topical application of mercurials causes the pus-

tules of small-pox to fade away. Mercurial frictions extin-

guish the erysipelas from the internal cause, which has somany points of resemblance to continued fevers. Lastly,mercurial inunctions over the belly cause the rose-colouredlenticular patches, which are developed on this region in pa-tients with typhoid fever, to disappear.These first facts assume a great importance, from the more

positive results that the examination of the general symp.toms furnishes. The diarrhoea and the tympanitic conditionof the abdomen are certainly, in a great measure at least,the result of the structural manifestation of the malady, fromthe irritation that the intestinal eruption sets up in the mucousmembrane of the alimentary tube. But under the influenceof the black sulphuret of mercury the diarrhoea abates, thestools become less frequent, when the medicine has exertedits purgative effects; the tympanitic state of the belly, pro.duced by the enormous disengagement of gas which takesplace in the intestine, from the influence of the eruptionlowering its vitality and destroying its tonicity, diminishesand disappears, or does not at all manifest itself, if the medi-cine is administered at the onset of the malady.

It is evident that this result must be attributed to thespecial action of the sulphuret on the cause of the morbidphenomena,-the intestinal eruption,-since we do not seesuch happen under the use of the ordinary purgatives. Itfollows, then, that the black sulphuret of mercury exercises,besides its purgative influence, a topical action on the intes.tinal eruption, which has the effect of preventing its develop-ment, or of arresting its progress when formed, and of remedy-ing, as a consequence, two grave symptoms of the disease-viz., the diarrhoea, which produces the prostration; and thetympanitic condition of the belly, which, joined with the con-secutive bronchitis, induces asphyxia.But these results are not the only ones brought about by

the administration, internally, of Ethiops’ mineral. If weattentively examine the influence it exerts on the entiresystem, we perceive that there is a more general action thanany of the foregoing displayed, which shows that its influencepenetrates deeper, and even seems to reach the cause itself ofthe disease.In fact, under the operation of the medicine in question,

the fever abates, the frequency of the pulse lessens, the de-lirium and cephalalgia are moderated; and all this in soevident a way, that it is impossible not to recognise in it theeffect of the medicine. By this plan, we cannot cut short theduration of the fever: it remains, as under all forms of treat-ment, for three or four weeks; but most frequently, when itis taken at its outbreak, we can place it in a statu pto that itruns its course without accident. In all the above facts weare supported by numerous cases. In a subsequent paperreadbefore the Academy, M. Serres brought forward numerouscases illustrative of the good effects of the medicine he hadadvocated.

____

On the Employment of Caustics in the Treatment of Oance:r,Scrqfulows Tumours, d-c., and on the Employment of Oulcineilalum as a DisÙ1jectantjo/- Wounds.Such is the title of an essay communicated to the Academy

by M. RIVAILLEE, and of which we give a summary:--1. The employ of caustics (nitric acid, Vienna paste, &c.)

for the destruction of cancers of the breast, of the neck ofthe uterus, and other organs, is, as a general rule, preferableto the use of cutting instruments ; and according to theauthor’s experience, caustics are as sure in their immediateeffects, and there is less danger of relapse, which seems dueto the property they possess of penetrating to the root of thedisease.

2. The caustic Al. Rivaille mostly employs, especially forvoluminous tumours formed of fungous structure, and disposedto bleed, is concentrated nitric acid. The acid, poured oncharpie, renders the latter a semi-solid mass, like paste, whichcan be exactly moulded on the parts with which it is to bebrought into contact, and beyond which its action does notextend. With this caustic, the writer says he has obtainedsuccess in extreme cases, and has never had to check hsemor-rhage or serious inflammatory accidents. He has also used thesolidified Vienna caustic, limiting its employment to scrofuloustumours and hard cancers having little disposition to bleed.

3. In several very grave cases, and especially in a com-minuted fracture of the two bones of the leg, followed by

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necrosis, he has had recourse to cauterization of the softparts surrounding the sequestra, and has thus rendered ampu-tation, apparently the only chance for the patient, unne-cessary.

4. Calcined alum, either in its solid form, or in solution,appears to be a valuable therapeutical agent for the dressingof wounds of all kinds; and it is a disinfectant agent, themost efficacious that can be employed. Under its influence,all putrid odour, gangrenous or other, promptly disappears,and pallid fungous wounds, of a bad appearance, assume verysoon a red colour, becoming clean, and tending to cicatrizein a regular manner. This alum may also advantageouslyreplace quinquina, to arrest the progress of putridity of gan-grene, &c.Of the utility of caustics, in many cases referred to by M.

Rivaille, there can be no doubt, but he seems disposed to carrytheir use to an extreme and injurious length, in which wethink no surgeon in this country would follow him; and,indeed, the use of caustics must in most cases be tedious, andexcessively more painful than the rapid removal of a diseasedpart with the knife. The use of calcined alum to wounds, webelieve, has been before advocated, but, perhaps, it ought tobe more extensively tried, for it is an agent of moderatepower, and readily procurable.

British and American Medical Journals.WOUND OF THE INTERNAL CAROTID ARTERY; DIVISION OF

THE PAR VAGUM.

In the Provincial uledical and Surgical Jour2tal, Mr. FEARNrecords the case of a female who was attacked by a man with aknife, and wounded in several parts of the head and neck.Severe hemorrhage from a deep source caused syncope.During this syncope the bleeding ceased, but returned againin a full stream. The internal carotid being supposed to bethe source of the haemorrhage, Mr. Fearn resolved on ligaturingthe common carotid, as the only means of arresting it. He

did so, and pursued the treatment of this severe and com-plicated case with much skill for a period of several weeks,when death terminated the patient’s sufferings. The writer’s

remarks, at the conclusion, will afford a better insight intothe progress of the case than a summary of the daily reportscould convey. lIe says :-"The chief points of interest may be briefly stated to be the

following:-lst. The extreme rarity of the occurrence of acase of wound of a vessel of so much importance as the in-ternal carotid, in which there is any opportunity of renderingsurgical aid. 2nd. The difficult deglutition and imperfectclosure of the glottis in the act of swallowing. 3rd. The ex-cited and variable state of the circulation. And lastly, theengorged condition of the pulmonary vessels, and the conse-quent suffocative cough and abundant bronchial secretion."With regard to the first point, I may state that I have

been unable to meet with more than one recorded instance inwhich the internal carotid was proved to have been injured,and in which the common carotid was tied. The case is re-lated in Mr. Cooper’s Dictionary, and was under the care ofAndersch; the common carotid was tied after a wound of theinternal carotid, and the patient died on the eighth day. Inthe present case, life was prolonged beyond the eleventh week;and looking to the state of the parts as revealed by the post-mortem examination, we may fairly be permitted to regard it,in a surgical point of view, as successful."Secondly, the difficulty of swallow ing and imperfect closure

of the glottis, which in the first instance were attributed tosome injury of the pharynx and upper part of the respiratorytube are beautifully explained by the fact of theparvagumhaving been divided. As one effect of this injury must be aparalysis of the recurrent laryngeal nerve, (a motor nerve,)and as it supplies the inferior constrictor of the pharynx, andthe crico and thyro-arytenoidei muscles, we are at no loss tounderstand the double embarrassment of the patient in theact of szaallowins. Indeed, so great was the distress occa-sioned, that at times it was almost impossible to prevail uponher to take even the smallest quantity of nutriment.

" The third and fourth points of interest-namely, the irre-gular and hurried state of the circulation, and the difficultrespiration, may properly be considered together. The irri,tation in the air-passages, and the abundant secretion and

cough, arose probably from congestion of the pulmonaryvessels, which I imagine to be caused by the sudden closure ofone important outlet from the left side of the heart. It wouldnaturally follow, if the free egress of the blood from the leftventricles were prevented, that the pulmonary veins mustbecome engorged, and, indeed, the whole thoracic circulationmust be obstructed-a condition which would give rise to greatirritation of the pulmonary organs, and the abundant mucoussecretion present in this case. A precisely similar state ofthings occurred in another patient upon whom I operated foraneurism of the arteria innominata, both after the ligature ofthe common carotid, and subsequently after tying the sub-clavian artery."

INHALATION OF ETHER IN CASES OF INSANITY.

The following report of the effects of the administration ofether to fourteen male and two female patients, in the NewYork State Lunatic Asylum, is taken from the AmericanJournal of Insanity. It is to be regretted that so little systemhas been observed in either the use of the remedy or thereports of its effects." Some patients have taken it once, several have taken it

three or four times, and a few eight or nine times." The cases in which we have used it have been various.

Some were cases of melancholy and of religious despair,others were affected by various insane delusions and halluci-nations, and some belonged to the demented class. To nonehighly excited or maniacal have we as yet given it."Some were not affected at all. One man and one woman

inhaled it for more than ten minutes without experiencingthe slightest change of feelings. Several seemed intoxicated,and said they felt as if drunk. One who had slept but littlefor several nights, and who usually slept poorly, rested re-markably well the night after taking it, and said he musthave taken a large dose of opium." Some have appeared better since they commenced taking

it, been more active, cheerful, and sociable. One who hastaken it nine times seems considerably improved. He was

previously dull, inactive, and unsocial, and his pulse but forty-eight in a minute. Since the use of the ether his pulse hasincreased to sixty-six in a minute. He is now cheerful andsociable, and works some. He says he is better, and thinksthe ether has benefited him.

" A few were highly excited by it. One man, who was in astate of religious despair, after taking it, awoke as from a ter-rific dream, and in a most violent rage seized the person whoadministered the ether. He afterwards said that lie at firstdreamed he was in hell, and that taking the ether had senthim there, and lience his rage and violence against the ope-rator." When this excitement abated, he seemed ecstatic with

delight on account of the visions he had seen, and the revela-tions that had been made to him. ’I floated away,’ he ex-claimed, I in infinity of space -I have seen a future world.What I have seen has proved the dogmas of religion; unlessa man comes up to an iota, it is over with him.’ When fullyrecovered from the effects of the ether, lie recollected the

assault, and begged forgiveness. _

" Some were pleasantly excited after using it. One danced.Another, when asked how he felt, after awaking from a shortsleep, replied, ’Exactly, exactly neat, by jingo-I never feltbetter in my life than I do now. Another, when asked by apatient to tell him what his feelings were, said he felt like akind of airy nothingness, as if he could fly.’ To none has itproved the least injurious, and we are rather favourably im-pressed with its use, though we do not expect any strikingremedial effects from it. We shall, however, continue ourinquiries, and shall endeavour to ascertain if there is notsome class of the insane to whom it is especially useful.STATISTICS OF MEDICAL COLLEGES IN THE UNITED STATES FOR

SESSION OF 1846-47.

University of Pennsylvania: Students, 411,-Medical Depart-ment of Trccnsylvazzica Unive1’sity: The number of studentswas 205; graduates, 62; two were admitted to an ad ezeredea7tdegree, and the honorary degree was given to four, making atotal of 68.-University of Louisville: Number of students,354.—Memphis Medical College: Number of students, 55.-Medical College of Ohio: Number of students, 170.—WesternReserve College: Number of students, 216.-Yale College: :Graduates, 28.—Willoughby Medical College: Number of stu-dents, 101; number of graduates, 38.—Castleton Medical Col-lege: Number of students in November last was 131, of whom42 received the degree of M.D.—Medical News, (Phila-delphia.)