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eminent as an antiseptic, but I believe very few are at allaware of its efficacy in various forms of arthritic, rheumatic,or even neuralgic maladies.I was first led to employ this auxiliary comestible, if I may

so term it, in cases where the alkaline treatment with col-chicum had totally failed. Persons whose digestive organswere deficient in the assimilating process, arising from imper-fect secretions, and producing foulness of breath and fcetideructations, were much benefited by the administration ofvinegar. Constant pains in the epigastric region after eatingor drinking, no matter what, although ordinarily digestible,are likewise symptoms which indicate its adoption. One cha-racteristic of its successful use is when all cloudiness of urinedisappears. I may further observe, that it is rarely in theyoung that this remedy is required ; those of middle age,whose constitutions have been injured by dissipation, will findgreat advantages from the use of the vinegar remedy afterthe colchico-alkali treatment has been proved of no utility.The distilled vinegar, or dilute pyro-ligneous or pyro-acetic

acid, may be administered in the following manner:-Aceticacid, one drachm; tincture of jalap, twenty minims; tinctureof orange-peel, one drachm; camphor mixture, sufficient for adraught, to be taken twice or thrice a day.The quantity of vinegar may be diminished or increased

according to the feelings of the patient and the effect pro-duced.-I am, Sir, your obedient servant,Romney-terrace, Westminster. Nov. 1847.

J. C. ATKINSON.

POOR-LAW MEDICINE.

CHARLES SMITH,Surgeon.

’1’0 the Editor qf THE LANCET.

SIR,—In THE LANCET for January 7th, 1847, p. 52, youobliged me so far as to make an extract from some statisticsI sent you of the diseases occurrent in my district, one ofthe most conspicuous features of which I earnestly solicityour especial attention to at this time-viz., the number ofcases of indigestion. Ever since I have undertaken the dutiesof union surgeon, I have requested the poor to apply to meimmediately they, or their children, were taken ill, and I be-lieve I have consequently prevented much illness thereby, asnot more than one in twenty of those cases required to applyto the relieving-officer. In my opinion, there is not a greaterfault in the present poor-laws, than the preventing the poorfrom applying to the surgeon until some actual disease hastaken place; and the altering of this clause I am convincedwould save much suffering to the patient, trouble to the sur-geon, expense to the parish, and in some cases, even deathitself. Permit me to suggest to you, that you could notconfer a greater benefit, either to the public or the profession,than (through the medium of your valuable journal) to advo-cate oT)r! chnw the necessity of the abrogation nf this clause

I remain, Sir, yours respectfully,Highworth, Wilts, Nov. 1847.

LIFE ASSURANCE.—MEDICAL FEES.To the Editor of THE LANCET.

SIR,-Knowing you to be the powerful advocate of the medical practitioners, and seeing, by your late impressions, thatmedical men begin to get alive to the injustice of the variousassurance companies requiring their services without remune-ration, and having been myself victimized by various com-panies, I have some time since resolved not to answer anyassurance company touching the health of a patient whomight apply for assurance, without previously receiving a feeof one guinea. I beg to place before you a case that haslately occurred to me, which will serve as an epitome for all.On the 5th of October last, I received a letter from the

Star Life Assurance Society, relative to the health of Mr.C-, a highly respectable tradesman of this town, whoapplied at the above office for the purpose of having his lifeassured. I acknowledged the receipt of this letter, andadded, that on the receipt of a post-office order for one guinea,I should have great pleasure in answering the various queriescontained in their circular touching the health of Mr. C-. .To this communication I received no reply. In about tendays afterwards, Mr. C- called upon me, to state that hehad received a letter from the secretary to the company,stating that Dr. O’Reilly refused to answer their letter withouta fee, and their Society must recommend him to submit him-self for examination before their own medical referee, thustaking away my patient, and placing him in the hands olanother medical man, who never attended him, and whocould not possibly know anything of his constitution. I may

be permitted to add, that Mr. C- offered me my fee, whichI refused, my object being, if possible, to establish a principle;and I trust that all duly qualified medical practitioners willrefuse to give any assurance company the required informa-tion, unless their circular be accompanied by the usual fee.-I have the honour to be. Sir. your verv obedient, humble ser-

I vant,Bishop’s Stortford, November, 1847

M. O’REILLY, M.D., M.R.C.S. & L.A.C.

(COPY OF CIRCULAR.)" To the Proposer’s Medical A tte2zdant.

Star Life Assurance Society, Moorgate-street, Bank.

SIR,—A proposal having been made to this Society for anassurance on the life of Mr. C-, and reference having beenmade to you for information respecting his present andgeneral state of health, I am desired by the directors to re-quest that you will favour them with answers to the followingqueries. Permit me to add, that it is important for the partyproposing the assurance that every question should be an-swered in as free and fair a manner as possible. As communi-cations of this nature are considered to be strictly confidential,and as a reason for declining a life assurance is never assigned,a perfect reliance may be felt, that should the tendency ofyour answers be such as to induce the directors not to acceptthe proposed assurance, the purport of them will never besuffered to transpire, or to become in any way the subject ofobservation.—I am resnectfullv. Sir. vour obedient servant.

Oct. 1847.W. E. HILLMAN,

Secretary.

’, P.S.-This extreme caution on the part of the assuranceI company is all very good, but it wont keep the pot boiling.—M. O’R. ___________

NEW PLAN OF POOR LAW MEDICAL RELIEF. To the Editor of THE LANCET.

SIR,—I enclose a copy of a paragraph which appeared in the’ Carnarvon and Denbigh Herald not long since. The descrip-’ tion contained in the first part of the paragraph is certainly3

very disgraceful, and shows how little the power vested inr guardians or commissioners has been exercised for the medical relief of the poor. It is, however, to the plan proposed in ther latter part of the paragraph referred to I wish particularly to* call your attention, and that of your numerous readers.i The plan appears very practicable, and will, in a great’

measure, I think, tend to obviate many of the objections made1 by medical poor-law officers to their present inadequatet amount of remuneration, and also the serious grounds of ob-jection raised to these parties by old established practitioners.’ Following out the plan I have referred to, it would be neces-

sary to enlarge, or rather, amalgamate several districts intoone, giving the whole of the present salary, if not more, to themedical officer of the district, who should be stringently boundto forego all private practice, and attend to the poor only. Amedical officer so appointed, and having an adequate annualsalary, might also act as an officer of health in his district, andnot onlv attend to the cure of the diseased Door of his district.but further, be invested with powers for examining into thesanitary condition of the whole of his district, and for takingsuch measures as may to him appear requisite for diminishingor warding off the virulence of epidemics, or protecting pre-sent health.

It is a serious objection to the present system of electingpoor-law medical officers, that by it, and it alone, any medicalman, whoever, whatever, he may be, obtains a certain statusor introduction to a locality, which tends to injure practiceswhich have been made by years of hard and sustained labour.Were it not that complaints on this head give a strong ap-pearance of disunion among medical men, I cannot helpfeeling very certain that many instances would be adducedin support of what I have just stated.

I fear, after all, that we are not an united profession, savingand excepting in the unity of the object--namely, the pro-tection, preservation, and restoration of health, which eachindividual member has in view.Without further remark, let me now call your attention to

the paragraph above alluded to:--, "MEDICAL RELIEF FOR THE POOR.—We are truly glad tofind that the asylum of medical relief for the indigent poor,’ within the Bangor and Beaumaris Union, is in a fair way of

being put upon an efficient footing. The system of medicalrelief within these districts is a disgrace to any civilized com-

munity; in fact, the inhuman neglect with which sick anddisabled paupers have been treated within many union dis-

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tricts deserves to be characterized, in the broadest sense ofthe word, as brutal. Parties have been engaged as unionmedical officers without the slightest inquiry as to the meanspossessed by them to discharge the duties, and whose totalstock of medicine and appliances was not adequate for thereception of a moderately filled dog-kennel. We learnthat there was, a short time ago, a medical officer to anextensive district in the county, with a population of 17,000inhabitants, consisting mostly of the labouring and poorclasses, whose whole stock in trade for supplying paupers,as well as private patients, including mortars, bottles, medi-cine-shelf, counters, and other shop-furniture, did not, whenfairly valued, exceed four pounds ! And we are credibly in-formed, that there are, in some parts of the country, at thepresent time, persons employed, whose total stock in trade, iffairly taken to-morrow, would not exceed half that amount.The plan proposed to be adopted, in the Bangor and Beau-maris Union, is to abolish all medical and surgical fees, forthe Board to provide all medicine and appliances, and toengage medical officers, at suitable salaries, tvho will have todevote their professional services exclusively to the indigent poorwithin their respective districts. The chief depcit for medicine&c. is proposed to be at the Union workhouse, with branchesin convenient localities. This humane reform originated withthe chairman of the Board, C. H. Evans, Esq., of Plasgwyn,and, as members of the committee, has been highly approvedof, and warmly supported, by Sir R. W. Bulkeley, the Hon.Col. Pennant, Dr. 0. 0. Roberts, Mr. Prichard, one of thevice-chairmen, and Mr. Evans, of Bangor. In fact, the com-mittee were unanimous as to the utter inefficiency of the pre-sent miserable system, and there were only two dissentientEfrom the propriety of adopting the plan proposed."

1 remain, Sir, yours faithfully, E. Al. R.November, 1847.

MEDICAL REMUNERATION.

To the Editor of TFIE LANCET.

SIR,—The following remarks are intended to apply moreespecially to club and poor-law union surgeons. I am fullyconvinced that the profession have looked at the utility ofunion and club practice in a wrong light. I believe surgeonsto such institutions are doing injury to themselves and theirbrethren, if not to the community. All may not see this, butI will endeavour to explain my meaning; and first, as regardsunion surgeons.

I am a young surgeon, and have just commenced practicein a country town. I have tour professional brethren, who, Iam sorry to say, are my opponents, and envious of my stand-ing and prospects, though a stranger. But I hope to live torender them good for evil. One of my brethren, who isconsidered the head surgeon by the people, has the unionpractice, but, like many others in a similar situation, does notattend to the pauper cases as he ought. He sees them seldom,and gives them the cheapest medicine, as salts, nitrate ofpotash, and the rest, which, if given in moderation, will doneither harm nor good. The result of such practice is, thatmany die under his hands, or they linger on in pain andmisery. This inattention causes ill-feeling amongst the poor.I could tell you of more than one instance of death caused byneglect. Now this conduct brings odium on himself and alsoon his brethren; for so many dying, naturally causes peopleto have, not only little faith in medicine, but makes them dis-posed to think all surgeons alike. Inattention and random

prescribing may be said to be owing to want of adequate pay,but in my mind this can be no reasonable excuse, for we andall men are bound to be charitable. These remarks would nothave been made if unions were not, as I think, an evil ratherthan a good. But I shall not discuss this point here.Many correspondents in your journal, of late, have shown

that their remuneration has been inadequate. This I believe;and I ask whether surgeons would not be more honourable,and show themselves more liberal, if they stood altogetheraloof from an office of this kind, and clubs and insurancecompanies as well. Would not this be advisable, rather thanto lower themselves and their profession by taking the low payof an union?

I live in a good prospect of having the union above referredto offered me, but I shall refuse it, for I have determined tocarry out the principle I have begun with. If a poor personcomes to me, and is not able to pay,-as many have,-I givethem all they require, as far as I am able,-advice, services,and medicine,-for nothing. If I cannot have the price I ask,I will take nothing. I have found that the acting in this wayhas been no loss to me; and if it proved so, I should leave

many behind me who would regret their loss. But in actingthus, I prevent a drain in another way-viz., by suspendingall subscriptions and donations to any charitable institutions.I have started a charity of my own, but I do not boast of it tomy neighbours; I keep it to myself, unless they want a reasonwhy I cannot make a subscription; so that what I might givein good and fair coin I give in medicine &c. Is this a rightor wrong system-a good or bad principle? Might not we alldo the same, and be both well rewarded and well respected?

I have had something to do with unions, and consequentlyknow what the feeling is amongst surgeons with regard todispensing medicines. They give as little as they can help,and at as cheap a rate as possible. I have been more ,thanonce checked while mixing up a bottle of medicine for apauper. The surgeons could not afford a bottle, and theytherefore send out pills wrapped up in paper without directions,or a powder in one mass, of which the patient must take ateaspoonful at a time, or as much as would lie on a sixpence.The evils of such a system are obvious.Now, with regard to clubs : In this town there are many

clubs, and there are few working men who are not in clubs.Each club has its surgeon. I accepted thesurgeonship of oneclub, which I gave up last week. The club consisted of fortymembers. I received two shillings a head from the members,and had to give advice, attendance, and medicines, for thispayment. I found that if I acted conscientiously, I could notdo this and he decently paid. I cannot do anything of thissort in an underhand way, and I must act conscientiously.Are all surgeons the same ? I fear not.

I accepted the club on the first of last July, and now I willgive you an account of the medicines I dispensed, and youwill see my gain:—Mixtures, twenty-eight; powders, three;pills, fifty-three; liniments, two; plasters, seven ; lotions, four.For the quarter, I was paid £1, and my expenses amounted,in providing the medicines, to at least as much as six shil-

lings and sixpence; so that out of the pound, I got, in profit,thirteen shillings and sixpence ! ! I have therefore given upthe club I had attended, and shall take no others, unless Ihave a better remuneration.

I should like to see surgeons standing aloof from under-selling ; for I am sure that would be a great means of raisingthem in public estimation. Their present plans would appearto show, that they wish to be considered a trading commu-nity, though, if they were told so, they would deny the fact,and be offended. Nobody could cast a greater odium on aman, in my mind, than to call him an union or club doctor.He likes the money, but does not like the names, " clubdoctor," " union doctor." Many are supported entirely onclubs and unions. Some are of opinion that clubs bringpractice. I doubt this; and I confess, for my part, that theclub I lately had did not bring me a single farthing morethan what I should have had without it; and may I askwhether others cannot say the same ?

I am quite opposed to the office of club surgeon, then; andI may ask, whether it would not be as reasonable for themembers of a club to go to a butcher, a baker, a tailor, adraper, and others, and ask them to undersell their articles,for the small allowance they would offer. The plan is thesame, but how laughable ! and is it likely that a butcher, abaker, a tailor, &c., would get more custom because they hadaccepted a club, and had agreed to provide its memberswith any articles in which they traded. If surgeons wouldbe reasonable in their charges, and would give up clubs andunions, I am certain their profits would be greater, and thesystem would be more satisfactory.Hoping these remarks will receive insertion in your excel-

lent journal, I beg to remain, Sir, yours, &c., D. B. ANovember, 1847.

D. B. A.

’ We insert this letter, not because we entirely approveof it, but because it undoubtedly contains a vein of truth,particularly with reference to the injury inflicted on the pro-fession generally by the Union system, and also as regardsthe haste with which medical men accept these appointments.-ED. L.

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CHARITY OF POOR-LAW GUARDIANS.To the Eclitor of THE LANCET.

SIR,—In the admirable crusade, which you have been thefirst to preach, against the system of payment of medicalofficers adopted under the new poor law, which preaching has,at last, aroused the " Jupiter Tonans" of The Tinzes to launchhis thunderbolts, not without fitting occasion,-" Nee Deusintersit, nisi dignus vindici nodus inciduit,"-you appear to