CONVENTION OF POOR-LAW MEDICAL OFFICERS.

188 The ureters were congested. The coats of the bladder were thickened; the prostate enlarged. A loose mass, of a yellowish colour, was found in the bladder. Seated at the fundus was a small tumour, vascular and red in the centre, and yellowish at the sides. Another larger tumour presented itself on the side of the bladder above. These tumours resembled each other, all of them affording evidence of en. cephaloid, combined with fungus hsematodes. Vascular spots, similar to those in the bladder, were found in the pros. tate. The author drew attention to the difficulty of the diagnosis of malignant disease of the bladder. Neither the presence of blood in the urine, nor its persistence, was alone sufficient to determine the case. He believed the microscope presented the best means we possessed. The presence of the peculiar nucleated and fusiform cells of carcinoma were a sure indication of the presence of malignant disease. He referred to three cases, in proof of this position. The absence of these cells, though not always conclusive, was yet very DISEASE OF THE HEAD OF THE THIGH-BONE. generally indicative, of haemorrhage from the bladder, arising Afr. HENRY SMITH exhibited two specimens of the upper from some other source. In the treatment of these cases, extremity of the femur, consisting of the head and trochanter where the malignant disease was made out, great care should major, which had been removed from the living body by opera- be taken not to introduce instruments into the bladder unnetion ; the one by himself, and the other by Dr. Morris, of cessarily, as the fatal result must be hastened by such pracSpalding. Although the specimens indicated the same dis- tice. Sedatives, more especially opium and astringents, as ease, they differed materially in some respects, and Alr. Smith gallic acid, acetate of lead, and sesquichloride of iron, were exhibited them for the purpose of showing the pathological the principal remedies. blr. COULSON related a case of medullary sarcoma of the changes which take place in the head and neck of the tliiglibone in hip-disease, and how they differ according to the bladder, and exhibited a preparation. In this case, which length of time the disorder has existed. In the one case, occurred some years ago, great pain and suffering had followed when he had removed the bone, the disease had not existed the introduction of the sound. He thought that careful examore than two years: here the head of the bone was commination of the urine by the microscope would be the best pletely carious, but it retained its globular shape, and the means of discovering the nature of these diseases. neck of the bone was neither altered in its structure, nor was llr. 1-1. WALTON referred to a case of disease of the bladder, its natural relation to the shaft destroyed. The other specimen attended with haemorrhage, in which the urine was carefully was that from a youth who had had hip-disease for six years: examined by Dr. G. 0. Rees, but nothing was found to indihere the head of the thigh-bone had completely lost its cate carcinomatous disease, which was found to be very globular shape, was flattened out widely, and the neck of the extensive after death. bone was much absorbed; and instead of being at an oblique Mr. NUNN said that he had attended a case of disease of the angle with the shaft, it formed a right angle with it. Mr. prostate with Mr. Simon, in which that gentleman had diaSmith did not bring forward these specimens for the purpose gnosed carcinoma from the presence of the nucleated and of arguing about the propriety of the operation of excision of caudate cells in the urine. the head of the femur, as that was now a settled question, The PRESIDENT drew attention to the importance of using but merely with the object of showing the pathological differ- means for the arrest of haemorrhage in these and similar cases, ences in the bone, so beautifully marked. which was sometimes very difficult to arrest. Dr. LANKESTER read a paper on Mr. KESTEYEN had attended a case of fungus of the bladder. Stone had been suspected, and the patient was sounded by FUNGOID DISEASE OF THE BLADDER, AND ITS DIAGNOSIS. two eminent surgeons. In this case the bleeding appeared to The author’s attention was directed to this disease, and its be arrested by the administration of the tincture of sesquidiagnosis, by the following case:—A gentleman, sixtv-two chloride of iron. Between the haemorrhagic periods the urine years of age, was suddenly attacked, whilst working in his was quite clear, and free from albumen. Mr. HANCOCK agreed with Dr. Lankester as to the improgarden, with pain in his back, which was followed by the expulsion of some bloody urine. The pain in the back conti- priety of introducing sounds and catheters in these cases; when nued, with the bloody urine. He had recourse to medical once the disease was ascertained to exist, perfect rest and advice, but at the end of a twelvemonth he was no better: the administration of sedatives should be had recourse to. the pain in the back continued; there was also pain referred Dr. SmsoN recommended the administration of belladonna to the neck of the bladder, and shooting pains down the in cases of malignant disease. He had found it relieve effecthighs. He had suffered for many years from dyspepsia, tually every pain to which the body was subject, independent which was now very much increased. He had consulted of derangement of the brain. The dose he gave was half a several physicians and two surgeons at different times; and grain night and morning, gradually diminishing the dose. the sound had been passed several times, without a stone Dr. DANIELL suggested, that as the urine was mostly alkabeing discovered in the bladder, and with the effect of pro- line in cases of stone, and that it was acid in the cases related, ducing great pain and an increase of blood in the urinary it would probably assist in the diagnosis of diseases of the secretion. There was frequent desire to make water. The bladder. water passed was now sometimes bloody, and sometimes comMr. GOWER had seen very great benefit derived, in all cases paratively clear. It was acid to test-paper. On cooling, an of disease of the bladder, from the taking into the system large organic deposit, with lithate of ammonia, occurred. The quantities of gum. organic matters consisted of shreds of mucuiill pus, and bloodglobules. Albumen was precipitated by heat and nitric acid. CONVENTION OF POOR-LAW MEDICAL OFFICERS. No stone having been detected by sounding, the general symptoms of disease of the kidney being absent, and the haemorAs the opening of the present Session of Parliament drew rhage evidently proceeding from the bladder, and the urine near, the committee addressed a letter to M. T. Baines, Esq., M.P., containing mucus, pus, and blood-globules, the case was treated the President of the Poor-Law Board. After pointing ont the grievances of the medical officers, which as one of chronic inflammation of the bladder, with ulceration. With rest and sedatives, and afterwards copaiba, the patient are already too well known to the profession, the Committee their letter to the President thus :improved, and removed into the country. He again consulted concluded " Prior to the opening of another Session of Parliament, we a surgeon, who recommended the passing the catheter, and injecting the bladder. This was followed with increased bleed- would respectfully inquire if any, and what, measures of redress ing, great pain in the back and over the pubes, and constant you may have been able to project or mature, with the power desire to pass water. Diarrhoea and vomiting came on, already vested in your hands. and he rapidly sunk, eighteen months after the first attack. " Should you still consider these powers so limited as to preOn examination after death the left kidney was found double vent you from carrying out remedial measures, we would seek the natural size, and greatly congested. The right kidney your suggestions, and hope for your co-operation in obtaining was enlarged, and presented patches of granular generation. from Parliament an improved position for the Poor-law Medical Both pelves were congested, and contained puriform matter. Staff, and more applicable means of succour for the sick poor,"

gradually became unconscious; and, when seen by Dr. Woodfall, at four o’clock P.M., was in a state of profound coma. The measures resorted to for her relief were of no avail, and she died at three o’clock the following morning, nineteen hours from the commencement of the attack. The head was examined thirty-six hours after death. The substance of the brain was wounded in removing the calvarium, and a considerable quantity of blood flowed out. On the surface of the left hemisphere two thin plates of bone were found, of small size; and in the superior longitudinal sinus were two others, about an inch in length, and one-sixth in thickness, at the thickest part. The substance of the brain was generally soft. The floors of the lateral ventricles were stained with blood, which had filled them, but which had mostly escaped in opening the cranium. The softening was most marked in the posterior corner of the right ventricle, and in parts presented almost the appearance of pus. A.M., when she

189 The receipt of the letter having been acknowledged with merely which salaries should be computed for unions, it was stated, that official statement that " the Board would take the subject into the basis of calculation being determined,-namely, population, their consideration," it was judged expedient to seek an interview and number of cases a’.tended, (on an average of three years,)-it by deputation, that the important subjects adverted to in the would be easy for the guardians, or an inspector, to affix the letter, with others relating to union surgeons, might be discussed, amount to be paid to the several district medical officers :-thus, and that the opinion and proposed line of action of the Poor-Law in a metropolitan district, two-pence per head on the total popuBoard being ascertained, the future course to be adopted by the lation of an union (varying as to the amount of pauperism in its Committee might be better defined. several districts) might be apportioned in the following manner :Subsequently, a deputation, of which Dr. Hodgkin, Dr. Bar- Three halfpence per head to be paid to the medical officer of the nett, Mr. Liddle, and Mr. Lord, were members, attended at the more wealthy district; twopence-halfpenny to be paid to the Poor-Law Board, and had a long interview with Mr. Baines, the medical officer of the more pauperized district. The Poor-Law Board considered, that the readiness with president, and Lord Ebrington, the secretary. The subject matters of complaint having been fully and clearly stated by the which medical men sought the appointments presented a formidan

members of the deputation, the following is the Report which has able difficulty to further burthening the rates in these times. been sent to us of the remarks which fell from the president and The PRESIDENT having incidentally made allusion to the the two secretaries, Lord Ebrington and Mr. Nicholls, the last of Queen’s Speech, in reference to sanitary improvements, he was whom was a former commissioner. asked if, in his opinion, a union of poor-law duties and sanitary The PRESIDENT considered that he must in some degree have obligations might not be carried out under the General Board of been misunderstood on the former interview, respecting the Health ? The President begged to be excused expressing an power of the Board, he was quite aware of that; and on many opinion on this point. Much conversation having ensued on theoccasions it had been exercised favourably respecting the salaries subject generally, the President stated that he was not ie a posi-of the medical officers; but with respect to cholera and other tion to pledge himself to any particular course, observing, that epidemics, the Poor-Law Board had not the power to lay down great difficulties were in the way of a satisfactory adjustment of any prospective scale of remuneration for extraordinary services, the question. but the power of granting a reasonable compensation on account On the deputation retiring, and thanking the Board for the of such services was vested in the guardians, and that whenever patient and lengthened audience granted, Lord Ebrington re-an increase was proposed, the Board had always much pleasure plied, that they felt obliged for the many valuable considerations in confirming it. The general question of Poor-Law Medical and suggestions afforded by the deputation. Relief, with the scale of remuneration, was so beset with difficulties, owing to the discrepant interests of the parties concerned, that it appeared more and more difficult of adjustment the more it was looked into. The Board had no power to interfere, and order payment for such services as the Board of Health required, "Audi alteram partem." - the guardians had, however, by the proviso to art. 172 of the General Consolidated Order. Mr. NicHOLLs feared that if medical relief were rendered gra- A FEW QUESTIONS—NOT FOR THE FELLOWSHIP. tuitous to all, it would be open to much abuse, and throw great [REPLY OF DR. AYRES.] responsibility on the relieving officer. To the Editor of THE LANCET. Lord EBRINGTON said, even now, where there is no fixed the number of your journal for January 26th, I obsalary, a lax board of guardians and a lax relieving officer often SIR,—In place many more cases under the care of the union surgeon than serve a series of physiological questions, addressed to the pro the real poverty of the applicants render necessary. fession, by Mr. Jackson, to which, I think, it will not be diffiIt was stated that the gravamen of the complaints of the union cult to furnish replies, satisfactory, at once, to the writer, and surgeons rested upon the fact that there was not a fixed standard exonerating the teachers of physiology, and the practitioners of payment for medical services. of medicine, from the reproaches of Mr. Jackson, and the Mr. BAINES inquired what plan the Committee proposed for celebrated theologian and philosopher, Pascal. It must be obthat end? served, in limine, that the so-called questions are not so much It was replied that there was a very general opinion in the real questions as statements, put forward in the form of quesprofession, and that it was assented to by the old Poor-Law tions or arguments, after the Socratic method, and as such Commission, that an average payment of 6s. per case throughout they must receive replies. To commence with Mr. Jackson’s the country would be an adequate payment. The Committee sixth and concluding question, to which all the precedinghad anxiously deliberated on this subject, and believed that the questions tend. He asks:-" What will succeeding generasum named was a tolerably accurate approximation to a fair tions of physiologists think of their predecessors, who, up to standard of payment. the middle of the nineteenth century, could even tolerate, Lord EBRINGTON inquired by what means it was understood much more teach, such opinions as that the digested food, and that the value of a case could be determined? drink, pass from the alimentary tube into the lacteals, and It was explained that the two elements in constituting the through the mesenteric glands and thoracic duct into the left subclavian vein; and that it is the heart that propels the blood value of a case, were population and area. A discussion afterwards took place upon the mode of striking through the liver?" Here we have two assertions disguised as a scale of payments upon the elements of population and area. queries:-first, that the physiologists of the present day teach It was then asked whether the Board had it in contemplation that all the digested food; and drink, enter the circulation to bring forward any measures of redress during the present through the lacteal system; and, secondly, that the heart does Sessionof Parliament. not propel the blood through the portal system of vessels. The PRESIDENT replied that he was not in a condition to Now, as regards the first of these assertions, that physiolomake any pledge that he had. gists of the present day teach that all the digested food and It was then stated that it was very generally understood that drink are absorbed by the lacteals, and conveyed to the blood the Poor-Law Board were preparing a Bill providing for a through the medium of the thoracic duct, I may remark, either that a long period has elapsed since Mr. Jackson atsuperannuation fund for union officers. The PRESIDENT observed that it was true such a measure had tended lectures on physiology, or, that he has not consulted been in progress, but that he had not yet seen it. It was not the recent handbooks and treatises on physiology, none of intended, however, to embrace the medical officers within its which, so far as I know, justify his astounding question. Be it known, then, to Mr. Jackson, who so unmercifully falls foul provisions. Lord EBRINGTON stated the principle of the Bill was that of of the physiologists, that Majendie long ago proved, byexperilevying a per centage upon the salaries for the purposes of a ments, that veins absorb; that watery and alcoholic fluids refund, and was of the nature of an insurance, on the same principle ceived into the stomach are taken up by the veins, and not by as was acted on in the Treasury and other offices. the absorbents; and, as the whole of the venous trunks of the A hope was then expressed by the deputation that the Board stomach and intestines empty themselves into the portal vein,. would devise a means of enabling the medical officers to receive it is equally conclusive that such fluids pass through the porthe advantages of such a fund if they should so wish, by admitting tal, and not only the portal, but the pulmonic circulation, bethem to it as members, at their option. fore they enter the general circulation? Other experiments, Mr. NICHOLLS remarked, that this view had suggested itself tc on the transmission of colouring matters, that of rhubarb, forthem, and promised that consideration should be given to the example, were made in the earlier part of the present cen-tury-if my memory does not deceive me, by Sir Everard subject. In reply to a question from Mr. Nicholls, as to the mode in Home-have demonstrated, that while the colouring matter

Correspondence.