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sensation alluded to. He thought that the feeling mentionedwas often attributed to disease of the antrum, when in fact itreally arose from a membranous cyst which generally com-menced in the alveolus, and dilated the bone in the neighbour-hood of the antrum. Such a condition of parts was not un-common.

Mr. PART suggested whether the difference in the two sidesof the face, which was so often seen, might not arise from thedifference in the size and elevation of the antrum which had.just been demonstrated ?

Mr. CATTLIN thought that variations in the malar bone con-tributed somewhat to the appearances alluded to, but had nodoubt that the size and shape of the antrum materially affectedthem. He recommended that the sides should always be care-fully compared within the mouth prior to perforating the ante-rior wall of the antrum.

Dr. HILLIER proposed, and Mr. HAMWoRTH seconded, avote of thanks to the author, and the Society adjourned.

THE BRIDGEWATER UNION AND MR. SYMES.

REGINALD BURRIDGE, M.D.HENRY AXFORD, M.R.C.S. Eng.JAMES HAVILAND, M.R.C.S. Eng.G. A. STRADLING, M.R.C.S. Eng.ROBERT BAKER, M.R.C.S. Eng., &c.ALFRED HAVILAND, M.R.C.S. Eng.RICHARD AXFORD, M.R.C.S. Eng.JOHN PARSONS, F.R.C.S. Eng.HENRY LONG JACOB, M.R.C.S. Eng., &c.ROBT. R. SEWELL, M.B., M.R.C.S. Eng., &c.HORATIO N. TILSLEY, M.R.C.S. Eng., &c."

To Henry Symes, Esq., Surgeon, Bl’idgewate1’.The following address has been presented to Mr. Symes :-" We, the undersigned, feel that the time has now arrived

when we can without impropriety offer you the public assur-ance of our unfeigned sympathy and condolence upon the issueof your late struggle with the Poor-law Board.Having watched with much interest the progress of this

struggle, we are in a position to say that the decision of theBoard was contrary to fact; contrary to the evidence adduced;contrary to the feelings of your poor patients, as set forth intheir testimonial to you; contrary to public opinion, as evincedthrough the local and medical press and otherwise; and con-trary to the opinion of the mass of your professional brethren.Englishmen hate oppression and wrong; and whilst we can

vouch that your professional character will not suffer amongstmedical men under these harsh and intemperate proceedingsagainst you, we entertain a well-grounded hope that a generousEnglish public will incline to censure your persecutors ratherthan yourself.We beg to tender you our sincere and cordial sympathy, and

our regret for the injustice inflicted upon you.REGINALD BURRIDGE, M.D.HENRY AXFORD, M.R.C.S. Eng.JAMES HAW LAN D, M. R. C. S. Eng.G. A. STRADLING, M. R. C. S. Eng.ROBERT BAKER, iM.R.C.S. Eng., &c.ALFRED HAVILAND, M.R.C.S. Eng.RICHARD AXFORD, M.R.C.S. Eng.JOHN PARSONS, F.R.C.S. Eng.HENRY LONG JACOB, M.R.C.S. Eng., &c.ROBT. R. SEWELL, M. B., M. R. C. S. Eng., &c.HORATIO N. T1LSLEY, M.R.C.S. Eng., &c." "

GRIEVANCES OF POOR-LAW SURGEONS.

Wolverhampton Union, May 28th, 1858.SiR,-I am directed by the board of guardians of this union

to forward you the annexed copy of a memorial which has thisday been sent by them to the Poor-law Board, upon the sub-ject of the alleged grievances of Poor-law medical officers, andto request that you will lay it before the board of guardians ofyour union, in the hope that they will acquiesce in the viewsit embodies on the subject, and co-operate in bringing suchviews to the notice of the Poor-law Board.

I am, Sir, your obedient servant,ISAAC FELLOWS, Clerk.

To the Clerk to the Guardians of the_______Union.

The Memorial of the Guardians of the Poor of the Wolver-hampton Union, adopted at their Meeting held on May 28th,1858, to the Hon. the Poor-law Board,

Sheweth,-That your memorialists have had their attention drawn to

the proceedings of a deputation from a body calling itself ’’ TheSociety of Poor-law Medical Officers to your hon. Board.That your memorialists entirely disagree with the views ex-

pressed by that deputation, and believe that to establish a uni-form scale of remuneration at so much per case would result inexcessively overpaying the medical officers of thickly-populated

districts, where the cases are numerous, lie closely together,and are often of a trivial nature; while in rural districts, wherethe population is scant, where the proportion of sick to healthyis much less than in towns, and where the medical officerswould probably be sent to only the more serious cases, themedical officers would correspondingly suffer.That your memorialists think a charge of 5s. each case, with

travelling expenses and separate charges for medicines, &c.,would be more than any union could possibly afford, as theyfind that in this union the medical charges would amount to asum equal to a rate of from 4d. to 6d. in the pound.That so far from these appointments being little valued by

the profession, the experience of your memorialists teachesthem they are much sought after, as, whenever a vacancyoccurs, there is a great desire to obtain the appointment; nordoes a trial of the duties of the office lessen the favour withwhich it is regarded, which is clearly shown by the desire ofthe officers to have their appointments made permanent.But what your memorialists would chiefly deprecate is the

desire expressed by the deputation to have an advocate at thePoor-law Board. Your memorialists believe that if this wishwere acceded to, it would result in establishing an imperiumire iinperio, would destroy the subordination necessary for ad-ministering the Poor-laws, and would be detrimental to theinterests of the ratepayers throughout the kingdom; while itwould give to every other class of union officers a right toclaim the same indulgence, and we might have the spectacle ofa " workhouse master’s advocate, a " union clerk’s advocate,"

and others, taking their place at the Poor-law Board.Your memorialists therefore hope that your hon. Board will

refuse to accede to the wishes expressed by the deputation ofmedical officers aforesaid, but will continue so to act as tomaintain a just balance between the interests of all Poor-lawofficers, the poor themselves, and the ratepayers.

(Signed on behalf of the Board,)CHARLES LEE, Cleairman.CHARLES LEE, Chairman.

Correspondence.

POOR-LAW MEDICAL REFORM ASSOCIATION.

"Audi alteram partem."

To the Editor of THE LANCET.

SIR,-I shall feel obliged if you will favour me with space toaddress the Poor-law medical officers on subjects deeply affect-ing their interests.The reply of the President of the Poor-law Board to Mr.

Booth, in the House of Commons on June 10th (a copy of whichI append), is most important, as it proves that our past laboursare now in a fair way to meet their reward ; still we must con-tinue to be vigilant, as dangers beset our path-e. g., recentlythe Wolverhampton Board of Guardians have drawn up a me-morial, containing a tissue of misstatements, which they havepresented to the Poor-law Board, and pray" that they willrefuse to accede to the wishes expressed by the deputation ofmedical officers." Not content with this, they have also ap-pealed to all other unions for co-operation.The Bill for a superannuation fund for Poor-law officers, issued

by a committee in London, composed of nine masters of work-houses, fourteen relieving-officers, and ten clerks to boards ofguardians, requires our serious consideration, as by it a deduc-tion from the salaries of all officers, medical included, of twaand a half per cent. is to be made compulsory. In its presentstate I feel confident the proposed Bill cannot be worked, andwill not give satisfaction to the medical officers. A copy willbe found in Knight’s Official Advertiser, which is sent to theclerk of each union.The Friendly Societies Bill, now before the House, compelling

a gratuitous medical certificate in case of death, is unjust to thePoor-law medical officers, to whom it alone applies, and oughtto be opposed.The Vaccination Bill about to be introduced will require to

be narrowly watched, otherwise we may be offered an indignitysimilar to that which is threatened to be imposed upon ourIrish brethren, " sixpence per case for successful vaccination."Could the illustrious Jenner rise from his grave, would not hebe astounded at the niggard value set upon his immortal dis-covery ? Better far that they should vaccinate gratuitouslythan accept so paltry a payment.

j To be successful in our efforts to improve our position, re-

616

quires unity of action and ample means at command, withoutwhich our best endeavours may be unavailing. Some gentle-men have contributed most liberally to the Association fund;but a vast number have done very little, and many literallynothing. Since the commencement of this year, 593 medicalofficers only, out of the 3200, have sent subscriptioiis: this

apathy is unworthy a noble profession with so much at stake.For years past the Poor-law medical department has been in adegraded position, ground down to so low an ebb that resigna-tions have been most numerous, almost compulsory, twenty-nine having taken place during the last month. Surely, nowthere is a prospect of making ourselves respected by the guar-dians and the community at large, my friends will awake fromtheir lethargy, and prepare themselves to support the proposedBill of the president of the Poor-law Board, or to press uponParliament the necessity of its amendment, should such beneeded; and also to take their share in the support or rejectionof the other Bills. But this cannot be done without funds,printing on an extensive scale and a large and continuous cor-respondence being absolutely necessary. Surely a few shillingsfrom each member cannot be considered thrown away in anattempt to redress the wrongs of our oppressed brethren, omit-ting altogether the prospect of obtaining the .f231,000 men-tioned by Sir John Trollope, or even the 50 per cent. namedby the president, which is .6115,000 annual addition to oursalaries.

I have recently been in correspondence with the Poor-lawBoard on the subject of our salaries, and annex their last reply.

I am, Sir, vour obedient servant,RICHARD GRIFFIN, M.R.C.S.12, Royal-terrace, Weymouth,

Jiuie 14th, 1853.

Statentent of the President of the POO1’-law Board, copied from" 7%6 Times" of June llth:-

MR. EsTCOURT said that he had endeavoured to frame ameasure which should give satisfaction both to the Poor-lawmedical officers and to the public with respect to the com-plaints which were urged on both sides: by the former, thattheir salaries were inadequate and their position not such astheir professional status entitled them to; and by the latter,of the want of proper attention on the part of the medical offi-cers. He did not expect that that measure could receive thesanction of Parliament in the present session, but he hoped tobe able to lay it on the table, so that it might receive someamount of consideration.

____

Poor-law Board, Whitehall, June 9th, 1858.

SiR,—I am directed by the Poor-law Board to acknowledgethe receipt of your letter of the 1st inst., and to state that thePoor-rate Return for 1855, from which the amount (.6231,682)referred to by you is taken, does not give the information re-quired as to the proportion of that sum paid in salaries tomedical officers, in fees or other expenses. I am directed to

add, however, that a return is in course of preparation for theyear 1857, for the purpose of being laid before the House ofCommons, which will give the particulars relating to the me-dical relief for that year in very minute detail. The Boardwill readily furnish you with a copy of the return as soon as it?M enmnlp-i-,Prl- T nm <’n

COURTENEY, Secretary.

THE MARSHALL HALL METHOD OF TREAT-MENT IN ASPHYXIA.

HENRY R. SILVESTER, B.A., M.D. Lond.

To the Editor of THE LANCET.

SiR,&mdash;Your correspondent from Columbia, Tenessee, 17. S.appears to be much interested in the method of treatment irasphyxia recommended by the late Dr. Marshall Hall, anegenerally known as the "Marshall Hall" or "Postural Method.’Allow me, through the medium of your journal, to call hi:attention to the results of my experiments and observations orthis important subject.The principle involved in the postural method is precisely

the same as in a plan formerly much practised, in which simplecompression and relaxation of the chest were employed to in-duce expiration and inspiration. The difference is this, that inthe postural method the compression of the thorax is occasionedby the weight of the body of the patient resting on the chestduring the prone position, followed by the removal of the pres-sure and consequent return of the thoracic parietes to theirordinary level on the patient assuming the supine posture. Noattempt is made to enlarge the actual capacity of the chest by’inducing an elevation of the ribs, such as takes place on makinga deeu insnira.tion.

t3

t This method of treatment has been found open to some ob-- jections; for instance-; 1. Expiration is made to precede inspiration, whereas ori-T ginally expiration is second in order, and not the primary act.1 in still-born infants, whose lungs have never been inflated,; forced expiration at tirst is of course impossible.

2. The expansion of the thorax or inspiration, being depend-6ant on little more than the elasticity of the tissues, takes place- feebly, inefficiently, and therefore calls for some more active. mechanical aid.

3. It is scarcely possible to use the warm-ba:h, if indicated. in the case of a still-born infant, during the adoption of the. postural method.

4. The patient is liable to have the mouth and nose com-pressed, the face bruised, or the neck twisted, by the almostlifeless body being turned alternately on the chest and backfifteen times a minute for some hours; moreover to the operatorthis process is very arduous.

5. When the body is " turned on the face, and pressuremade on the back," (pronated,) the contents of the stomach areliable to pass into the cesophagus and windpipe.

6. When the patient is turned "completely on the side anda little beyond," (supinated,) the tongue obstructs inspirationby falling back into the throat, the epiglottis resting againstthe back of the pharynx.

7. Both sides of the chest are not equally inflated, one sideonly being called into action at the same time to any importantextent.

8. This process is not entirely in harmony with that ofNature. It is not the way in which we generally breathe.

9. That the amount of air respired is exceedingly small, ashas been proved by actual experiment. This is doubtless inconsequence of the actual capacity of the chest not being in.creased.The method of performing the experiments, at St. George’s

Hospital, on the dead subject, which appeared to prove thatin the Marshall Hall Method " nearly as much air entered thelungs as would be inhaled in an ordinary inspiration in a stateof health," is, I believe, by no means satisfactory; it is, infact, open to obvious objections. The tube of the pneeometer waspassed into one of the nostrils of the patient, the other nostriland the lips being closed with adhesive plaster. The want ofrigidity of the cheeks, and the amount of air in the respiratorytract, and even in the stomach, &c., of the patient, couldscarcely fail to render the indications of the instrument, how-ever perfect in itself, liable to suspicion, if not entirely value-less, in point of scientific accuracy.The method which I have ventured to bring before the pro-

fession, is not open to any of the above objections. It is asimple imitation of natural deep respiration, and effected bymeans of the same muscles as are employed by Nature in thatprocess. In ordinary deep inspiration, we lift the ribs andsternum by the pectoral and other muscles, which pass betweenthe chest and the shoulders, and thus produce the threatenedvacuum which inflates the lungs.

In my method we lift the ribs and sternum by the pectoraland other muscles which pass from the shoulders to the pari-etes of the thorax, by steadily extending the arms up by thesides of the patient’s head; by elevating the ribs the cavity ofthe chest is enlarged, a tendency to a vacuum is produced, anda rush of air immediately takes place into the lungs. Expi-ration is brought about by simple compression of the sides ofthe chest by the patient’s arms.The distinguishing feature of my method is the actual en-

largement of the cavity of the chest.In order to maintain a free entrance of air into the wind-

pipe, we draw forward the patient’s tongue, and keep it pro-jecting beyond the lips. If the lower jaw be gently raised,the teeth may be made to hold the tongue in the requiredposition. Should it be found necessary, the tongue may be soretained by passing a handkerchief under the chin and fasten-ing it over the head.

In this way the patulous orifice of the windpipe is raisedand drawn forward, so that nothing intervenes between it andthe natural channel of air through the nose. The tongue isentirely prevented from falling back into the throat, whilstthe extent to which the windpipe put on the stretch is clearlyindicated; the pharynx also is sufficiently opened to allow ofthe removal of liquids, so., from the mouth, nose, pharynx, &c.My method has been tested by experiment on the dead body

with most satisfactory results; and a successful case of resus-citation has already been recorded.-Yours obediently,

HENRY R. SiLTESTEK, B.A., M.D. Lond.High-street, Clapham, June, 1858.