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In other cases, anæmia goes to prove that some state of theblood is an essential element in the occurrence of dropsy. I

In regard to cardiac disease, valvular lesion is the mostcommon cause of dropsy, and hypertrophy the least so, whichshows that the production of dropsy depends upon some failureof the vis à tergo, a view borne out bz- a careful analysis of the ’,various cases. In mitral disease the danger does not depend ’,upon the loudness of the murmur, but upon the feebleness ofthe pulse, and in aortic disease dropsy seldom occurs untilregurgitation is established. An increased circulation alone,too, is barely a cause of dropsy, unless some obstruction existsto the circulation of the blood, or there be an abnormal ten-dency to transudation of serum. Bronchitis, whether due tocongestion of the lungs, from mitral regurgitation, or from

exposure to cold, is one of the diseases which act in thismanner. A similar (but a more fatal) result is seen in obstruc-tion to the circulation through the liver, and in all these casesthe other causes which of themselves originate dropsy maycome into play. With regard to valvular disease, we mustbear in mind its detection at an early period, while alterationof the size of the heart only becomes manifest after it hasacquired a certain degree of intensity, which fact, though itmay have much effect upon the numerical relations of thelesions, still is of little importance, as the dropsy never

occurs in an early stage of either form of disease. He then re-marked,-

1. That a systolic murmur may co-exist with dropsy andyet have nothing to do with its production, the cause beingsimply an anæmic condition of body.

2. That hypertrophy of the heart may be masked by em-physematous lungs, leading one to the supposition that eitheratrophy or dilatation of that organ existed.

3. That a mitral murmur may be covered by a turbulentaction of the heart.

4. That cases occur in which regurgitation through themitral valves depends upon hypertrophy, a condition leadingto no error, as the results are the same whatever the cause ofthe regurgitation.The relation of kidney disease to dropsy was then discussed,

in which he stated that each stage of the disease was markedby a peculiar state of the urine. In the early stage the urineis generally clear and free from albumen, though this conditionof the secretion sometimes is found in advanced stages of thesame disease, which must make us careful in our examinationsof the urine, and in forming our suspicions as to the degree ofrenal change. In the congestive stage, albumen is present,and in acute cases of dropsy, as after scarlatina, it is found insmall quantities only in comlexion with an abundant supply oflithates. In the hæmorrhagic stage, the albumen is most

abundant, but will be found to bear no relation to the bloodpassed. Diseased kidney acts in the production of dropsy intwo ways-by suppression of urine, and by causing a drain ofalbumen and salts from the body, in consequence of which theblood becomes impoverished, and when disease of the heart ispresent it is not difficult to see this morbid state act withincreased energy in company with albuminuria. In ascitesthere is more obscurity, and though the dropsy may arise fromobstructed circulation through the liver, it may also happen ifthe mutual balance between absorption and secretion of theperitoneal surface be destroyed. But the dropsy may be dueto some general disease of the svstem, and be associated withanasarca, in which case some distinct cause will be found forthe latter. A diseased state of the peritonæum, including in-flammation and malignant conditions of that membrane, mayalso cause ascites, and as either may be associated with renalor cardiac disease, it is clear that all such cases are connectedwith and dependent on some obstruction to the onwardcurrent of the blood. As dropsy seldom depends upon themorbid state of any organ alone, but generally in connexionwith some functional disturbance of it for the time being,these superadded causes are amenable to treatment, thoughthe original one may not be. In simple uncomplicatedanasarca (as after scarlatina) we have simply to counteract thesuppression of urine, but in other cases ’B’B e must improve thetonicity of the blood and system generally. When the kidneysare congested and effusion is an immediate result, we shoulduse the intestines and the skin as our channels for the dis-charge of the serum rather than the kidneys. In complicatedcases, we often have irritation to soothe and inflammation tosubdue before the dropsy be attacked. In chronic bronchitis,in connexion with these cases, we must attend to the generalhealth, rather than use expectorants. The heart must bemodified by digitalis, and the blood improved by iron, and thekidneys excited by vegetable salines and buchu, rather than

by more powerful diuretics. Purgatives are doubtful remedies,and promise most good in ascites.The discussion which followed embraced the subject of

acupuncture in cases of dropsy, which was strongly recom-mended by some members present.The society then adjourned until February 3rd.

MEDICAL MEETING AT CROYDON,TO MEMORIALIZE LORD PALMERSTON ON THE SUBJECT OF "THE

COMPULSORY VACCINATION EXTENSION ACT."

I consequence of the difference of opinion which has arisenbetween boards of guardians and the medical profession on thesubject of this Act, meetings have been held in many parts ofthe country for the purpose of petitioning Parliament for a re-vision of some of the clauses of the Act; and with that viewa meeting of the medical profession of Croydon and its vicinitywas held at the Town Hall, on Thursday evening, the 19th inst.,which was convened by the following circular, issued by Mr.Berney. the chairman of the Vaccination Committee :-

I "Croydon, Jan. 14,1854.I "My DEAR SIR,—Having been requested, as chairman ofthe Vaccination Committee, to convene a Meeting of our pro-fessional neighbours, for the consideration of the vaccinationquestion, which has just now an additional interest on accountof Lord Lyttelton’s contemplated modification of the Act, mayI beg the especial favour of your presence at the Town Hall, onThursday, January 19th, at seven o’clock in the evening pre-cisely, that we may derive the mutual advantage of professionalexperience and counsel.

" The almost entire unanimity displayed by the practitionersresident here, and those in our immediate vicinity, leads me tohope and believe that the same adhesion to correct and soundprinciples will manifest itself at the forthcoming meeting, andthat nothing but professional engagements will prevent yourattendance ; more especially as it is no longer a question withboards of guardians, but a means of enabling Lord Lyttelton toarrive at a conclusion as to what the profession considerbeneficial for the population at large, and satisfactory to them-selves. " EDWARD BERNEY.

" P. S. -If inconvenient to attend, please to forward, undercover to me, your views and opinions."

Letters were received in favour of the objects of the meeting,and expressive of regret for their unavoidable absence, from thefollowing gentlemen :-Messrs. Alexander Brown, (Streatham;)Alfred Brown, (Wandsworth ;) Bird, (Croydon;) Gilbert,(Sydenham;) Hassell, (Wandsworth;) C. Holman, M.D.,(Reigate;) Holt, (Bromley;) Leese, (Norwood;) Martin, (Rei-gate ;) Sargeant, (Reigate;) Ridge, (Putney;) and Thompson,(Westerham;) but there were present Messrs. Bottomley,Boulger, M. D., (Bletchingley;) E. Berney, Clever, A. Car-penter, Careless, {Beckenhaxn;) Gore, M.D.; Hubbert, Henley,Markwick, Roper, Sutherland, Stilwell, (Epsom;) Shorthouse,M.D., (Carshalton;) Richardson, (Mortlake;) and Westall,(Croydon.)Mr. E. BERNEY, in opening the business of the meeting, said

that they had been convened by a circular, to take into con-sideration the provisions of the Public Vaccination Act, which,in his opinion, required some modification, and was, as at pre-sent framed, thoroughly inefficient and unworkable. To thecredit of the medical gentlemen then present, not one of themhad tendered themselves for the vacant office of public vacci-nator. With that short preface, he would conclude by proposingthat Mr. Edward Westall do take the chair. The propositionhaving been seconded, was carried unanimously.

Mr. WESTALL, on assuming the chair, expressed his opinionthat Mr. Berney would have filled the chair more ably thanhimself, inasmuch as he had acted as chairman of the Vaccina-tion Committee, and, as such, had taken the initiative in theirproceedings. A memorial has been prepared, which suggestedthat the working of the Act should be placed under the controlof the Registrar-General, and that every legally-qualinedmedical man should he a vaccinator. The chairman concludedby calling upon Mr. Berney to read the memorial addressed toLord Palmerston, and the resolutions proposed to be submittedfor the approval of the meeting.

Mr. BERNEY said that the resolutions were, of course, opento modification; he would now read the memorial :-

" To the Right Honourable the Lord Viscount Palmerston,M.P., Her Majesty’s Principal Secretary of State for theHoane Department.

, "We, the undersigned medical practitioners of Croydon and

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the surrounding neighbourhood, feeling that the late Act,entitled " The Cumpulsory Vaccination Extension Act," is inits details such as to interfere with the intention of the legis-ture to disseminate the blessings of vaccination, respectfullypray your lordship’s attention to the following points, viz.:-

’’ In some of its special features it is repulsive to the greatbody of the profession, although in a slightly altered or modifiedform we are sure that the Act would be substantially and wellcarried out by medical men generally, through whose instru-mentality only it could work satisfactorily to the legislatureand beneficially for the public.

"It seems to us also desirable that the appointment shouldnot rest with the boards of guardians, bodies who are not heldin the highest repute by medical men, and are too often com-posed in country districts of men not administering the law inits liberal spirit or in the most conciliatory manner, and inmany instances not adopting the excellent suggestion of LordLyttelton to appoint every practitioner a public vaccinator,but instead of acting upon such a recommendation, appointingperhaps one or two public vaccinators in an exceedingly popu-lous district, putting it out of the power of the vaccinator todo his duty, even with the best intention to carry out the lawin all its particulars, and when your lordship is further in-formed that the boards of guardians generally offer the lowestscale of fees that the Act of Parliament admits of, it will beevident that there is but little inducement on the part of theappointed vaccinator to grapple with the difficulties of hisoffice.

" We, the undersigned, therefore, with due submission toyour lordship’s opinion, beg to suggest-Firstly, that everylegally-qualitied medical practitioner be appointed a vaccinator.Secondly, that the carrying out of the Act be confided to theRegistrar-General; and, lastly, if of necessity the powerremains vested in the board of guardians, that a remunerativefee shall be fixed by an additional clause in the Act for theduties imposed."Mr. STILWELL (Epsom) objected to the remarks contained in

the memorial just read, which he thought reflected unfairly onboards of guardians generally; they certainly were not all asdescribed - some, indeed, bore a very high character - andhe did not think, therefore, that they ought to reflect on theboards generally. As to the proposition for making everymedical man a public vaccinator, he would suggest not thateveryone should be so appointed, but that they should all beat liberty to register the cases they vaccinated. Many chil-dren differed in health and strength-some brought from adistance were liable to take cold, particularly at an inclementseason of the year. He was of opinion that a period of threemonths, limited by the Act, was too short ; besides it was im-possible for medical men to keep the number of books theywere required to keep ; a portion of them might be supersededby a certificate being left with the parent of the child Yac-einated, and a duplicate kept by the practitioner; another

objection was as to the remuneration affixed, but he fearedthat neither that or any other meeting would be able to fix aspecified sum; he would, however, move that the words"public vaccinator" be omitted, and that every properly-qualified medical man be paid for the certificate of every suc-cessful case.

Mr. SUTHERLAND was of opinion, from the little experiencehe had had, that Mr. Stilwell’s objections would interfere withthe working of the Act, and give more trouble than wasalready imposed upon them.Mr. BOTTOMLEY, who arrived late, (after having the me-

morial read to him,) proposed that that part which related toboards of guardians be omitted altogether.The CHAIRMAN inquired whether Mr. Bottomley would put

his suggestion in the form of a resolution’? ’?Mr. BOTTOMLEY would omit all that referred to boards of

guardians, who were not fitted to carry out the Act : he wouldsuggest that a deputation should wait upon Mr. Alcock, whowould go with them to Lord Lyttelton, and from thence toLord Palmerston, which would be proceeding step by step pre-paratory to their entering both Houses of Parliament. Byadopting the suggestion he had just made they would steerclear of all personal attack, derogatory to their characters asmedical men, and thus pursue a straightforward and manlycourse.

Mr. BERNEY concurred with Mr. Bottomley, that boards ofguardians were not proper persons to carry out the provisionsof the Act.Mr. STILWELL stated, that one fact he had ov erlooked-viz.,

that boards of guardians had to deal -with paupers only. TheAct extended to all persons ; and, therefore, that reason ought

to be assigned, inasmuch as they had to deal with other thanpaupers.j Dr. BOULGER said, that whenever he had any sanitary mea-sure to bring before the heard of guardians, he had never foundthat they were calculated to give effect to his recommendation.

Other gentlemen present concurred in the observation of thelast speaker.

Mr. SUTHERLAND said, that one great objection to thosegentlemen having the control of the Act was their treatment ofmedical men generally. He certainly had not personally ex-perienced it; but their Croydon board had treated Mr.Bottomley very batlly, and Mr. Hubbert even worse, and forno cause whatever that he had heard of.

Mr. RICHARDSON made some remarks on the imperfectionsof the Act.

After a short debate upon the question, the majority of themeeting being in favour of a memorial, Mr. Carpenter ex-pressed himself also in favour of the memorial, and a deputa-tion, as proposed by Mr. Richardson, as they would then beenabled to answer any questions that Lord Palmerston wouldask, thus giving effect to their opinions more forcibly.The two first paragraphs of the memorial were unanimously

approved of and adopted. The third paragraph ran as fol-lows, viz. :- ‘ It seems to us also desirable that the appoint-ment should not rest with boards of guardians, but in lieuthereof be intrusted to the Registrar-General."Mr. CLEAVER proposed a resolution, which was seconded by

Dr. GORE, and carried unanimously, ’’ That a deputation, con-sisting of Dr. Gore, Messrs. Cleaver, Carpenter, and Berney,be appointed to wait on Lord Palmerston with a memorialfrom this meeting."Mr. SUTHERLAND moved a resolution, which was seconded

by Mr. ROPER, and carried unanimously, "That the membersof the deputation place themselves in communication with thedeputation from the Metropolitan Branch of the Medical Pro-vincial Association."A discussion of some duration then ensued with reference to

the extension of time, and the number of forms required to bekept, in which Messrs. Sutherland, Stilwell, Cleaver, Richard-son, Berney, Jeynes, and Dr. Gore took a part, when ulti-mately the following resolutions were put and carried unani-mously :-Moved by -A,-Tr. BOTTOMLEY and seconded by Mr. BERNEY:—

" That the performance of vaccination be placed in the handsof all legally-qualified members of the profession, and thatthey be paid for certificates in all successful cases."Moved by -A-Tr. CLEAVER and seconded by Mr. CORLESS:—

" That the time for compulsory vaccination be extended to sixmonths." "

-

Moved by Mr. BERNEY and seconded by Mr. BOTTOMLEY:—"That one, or at most two forms of books be required forregistration."Moved by Dr. SHORTHOUSE and seconded by MR. SUTHER-

LAND :—’ That the carrying out of the Act be confided to theRegistrar-General."The CHAIRMAN said that, for all practical purposes, the Act

as at present framed ".-,t8 ine6ieient for so large a district asthis. One vaccinator, as now appointed, was quite insufficient.

Mr. JEYNES could not see that, for he had nothing else todo but to vaccinate. (i.aughter. )Mr. CARPENTER believed the Act to be inefficient, because

the board of guardians had iniiicterl great injustice upon themedical profession, simply for the sake of saving a few shillings.Mr. JEYNES said that he thought so too.Mr. SUTHERLAND was cf opinion that it was hardly worth

while discussing that question then, more particularly as thegentleman who had just spoken was the chief cause of thatinjustice.

On the motion of Mr. BOTTOMLEY, seconded by Dr. BOULGER,the thanks of the meeting were unanimously awarded to theChairman, for his kindness in presiding over them that evening.The CHAIRMAN briefly acknowledged the compliment, and

expressed his obligations to those gentlemen who had comefrom a distance to be present there on that occasion. Theproceedings then terminatecl.

ADDRESS AND REPORT OF THE PROVISIONALCOUNCIL OF THE SOUTH LONDON MEDICAL AS-SOCLATION.

Provisional Council.—Dr. Barlow; Dr. Bateson; C’hariesBrady, Esq. ; Johii Brady, Esq., M. P. ; Edward Doubleday, Esq., Treasurer; Edward Evans, Esq., Chairman; H. B.