132 GLOUCESTERSHIRE AND BRISTOL SURGEONS—POOR-LAW MEDICAL CONVENTION.

the president, the honorary secretary (himself an F.R.C.S.E.),and the members of the Gloucestershire Association, is de-serving of the highest praise, and is well worthy of imitationby every branch association in the kingdom. They havetaken the trouble to meet, to pass and publish their resolu-tions, and both to memorialize the Home Secretary and topetition Parliament; and we do not know a more efficientmode of making themselves heard in the right quarters. We etrust we shall have to record many other county meetings, theeffect of which upon the great peccant body, the College ofSurgeons, cannot but be most salutary. Again we commendthe Gloucestershire meeting as an example to the medicalpractitioners throughout Great Britain.

PETITION OF THE SURGEONS OF GLOUCESTER-SHIRE.

To the Horaourable the Commons of the United Kingdom of GreatBritain and Ireland, in Parliament assembled.

The humble petition of the undersigned members of theGloucestershire Medical and Surgical Association,

’

Sheweth,-That the charter granted to the College of Sur-geons in 1843, forms an insurmountable obstacle in the pathof medical legislation, and that no attempt to adjust, by Actof Parliament, the difficulties of this subject, can be successfulor satisfactory, until the injustice perpetrated by that ob-noxious measure be done away with.That the Colleges of Physicians and Surgeons, if rightly

organized, are quite sufficient for the requirements of the pro-fession in this country, and that the proposed creation of anew corporation, for the enrolment of the general practi-tioners, is uncalled for by any necessity, and that such newinstitution would be alike injurious to the interests of the pro-fession and the public.

That the parties who have undertaken to appear, on thepart of the general practitioners, in the conferences whichhave led to the proposal of a new corporation, have no titlewhatever to be considered as representing the views and.opinions of that great body of the profession.

That the foregoing statements of opinion are copies of cer-tain resolutions proposed at a special general meeting of theGloucestershire Medical and Surgical Association, held atCheltenham, on the 20th instant, and passed unanimously.Your petitioners therefore humbly pray, that as a pre-

paratory step to any measure for the regulation of the medicalprofession, the provisions of the charter granted to the Col-lege of Surgeons in 1843, and the manner in which they werecarried out, may undergo a searching investigation, and thatyour honourable House will be pleased to reject any Bill,concerning the medical profession which shall tend in anyway to perpetuate the injustice inflicted by the said charterupon the great body of the members of the College of Surgeons.And your petitioners will ever pray, &c.

Signed on behalf of the members of the GloucestershireMedical and Sursical Association.

THOMAS WRIGHT, M.D., President of the Association and Chairman of the Meeting.

JOHN WILLIAM WILTON, F.R.C.S.E.,Honorary Secretary.Gloucester, July 21st, 184E

At a special general meeting of the members of the Glou-cestershire Medical and Surgical Association, held at Chelten-ham, on the 20th day of July, 1848," To take into considerationthe proposals for a measure of medical reform, lately pub-lished, as resulting from a conference of parties representingthe metropolitan corporations and the general practitioners,and intended as the basis of an act of parliament for the regu-lation of the profession,"-Thomas Wright, Esq., M.D., presi-dent, in the Chair, the following resolutions were carried una-nimously :-

1. That the charter granted to the College of Surgeons in1843, forms an insurmountable obstacle in the path of medicallegislation, and that no attempt to adjust by act of parliamentthe difficulties of this subject can be successful or satisfactoryuntil the injustice perpetrated by that obnoxious measure bedone away with.

2. That the Colleges of Physicians and Surgeons, if rightlyorganized, are quite sufficient for the requirements of the pro-fession in this country, and that the proposed creation of a

new corporation, for the enrolment of the general practi.tioners, is uncalled for by any necessity, and that such newinstitution would be alike injurious to the interests of the pro.fession and the public.

3. That the parties who have undertaken to appear on thepart of the general practitioners, in the conferences whichhave led to the proposal of a new corporation, have no titlewhatever to be considered as representing the views andopinions of that great body of the profession.

4. That this Association pledges itself to oppose, by allmeans in its power, the adoption of any legislative measureswhich may tend to perpetuate the injustice inflicted upon themembers of the College of Surgeons by the Charter of 1843.

5. That a memorial be forwarded to the Secretary of State,and a petition presented to the House of Commons, embody.ing the foregoing resolutions; and that a committee be ap-pointed for the purpose of drawing up such memorial andpetition, and giving publicity to the proceedings of the meeting,

J. W. WILTON, F.R.C.S., Hon. Sec.J. W. WILTON, F.R.C.S., Hon. Sec.

PETITION OF SURGEONS OF BRISTOL, &c.

To the Honourable the Members of the Commons of England,and Ireland appointed a Committee to Investigate and PC-port on the subject of Medical Reform.

We, the undersigned members of the medical profession,respectfully and earnestly entreat of you not to countenanceor to recommend to parliament any measure of medical reoform which shall not have for its main objects-

1. The maintenance of all our rights and privileges as mom.bers of the Royal College of Surgeons of England.

2. The establishment of an uniform system of medical edu.cation and test of qualification in each division of the UnitedKingdom.

3. The protection of the medical profession and the publicagainst the practice of any branch of medicine by unqualifiedpersons.We also implore you not to consider your investigation com.

plete, until some members of the College of Surgeons aforesaid,totally unconnected with corporate favours, have been ex.amined by you, and to recommend to parliament to hastenthe passing of some measure of medical reform worthy aliberal, enlightened, and learned profession, that thereby theheart-burnings which have so long existed, to the detrimentalike of the public and the medical profession, may be set atrest.

And, as in duty bound, your petitioners will ever pray, &e,(Here follow sixty-four signatures.)

.

REPORT OF THE COMMITTEE OF THE CONVEN-TION OF POOR-LAW MEDICAL OFFICERS, JULY,1848.

WANT of space prevents our publishing, as requested, in the 2present week, the whole of this Report, but in order that itsprincipal portions may be before the whole profession withoutdelay, we present to our readers the following

ABSTRACT.

The committee appointed at the convention of poor-lawmedical officers, held at the Hanover-square Rooms, on

Wednesday, October 27th, 1847, consider it right at this periodto place a report of their proceedings before their constituentsand the profession generally.The resolutions passed at the convention have been con-

sidered by the committee as " instructions" or "suggestions,"by which to shape their proceedings. They may be summarilystated as follow:- .

I.-That the highest qualification of a cultivated mind andprofessional capability, with great expenditure of time andphysical strength, are perpetually called into operation throughthe poor-law surgeon for the benefit of the sick poor; thatthe present system is so essentially faulty, that the surgeon isinvariably unfairly dealt by, and the sick poor are more orless injured.2.-That the payment given by boards of guardians is

utterly out of proportion to the duties, exertions, and ex.

penses which devolve on the medical officer, as well as to theadvantages conferred on the suffering paupers.3.-That to remedy these grievances the convention pledges

itself, by its standing committee, to use the most perseveringand temperate means, to collect and digest information on thesubject; to memorialize the Secretary of State for the HomeDepartment and the Poor-law Board, and to communicate

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with the Colleges of Surgeons and Physicians, and othernfluential and corporate medical bodies.From the report on collating the returns made by poor-law

medical officers, the following extracts are of most significantimportance:-"Returns have been received from 434 unions, comprising

no less than 805 medical districts, which, considering thelaborious and time-engrossing occupation of the poor-lawmedical officer, may be considered a very large proportion."The whole of the returns have been arranged in eleven

divisions, corresponding with the eleven divisions adopted bythe registrar of births, deaths, and marriages, and the poor-law commissioners."-The salaries received are generally stated with sufficient

clearness, and the averages set forth in the tables may berelied on. With regard to the amounts received for extras,however, there is great difference, many including therein theamounts received for midwifery, vaccination, surgical opera-tions, trusses, and other appliances-and others stating theamount exclusively of some one or other of these. Thedifference those exclusions make in the deductions is, how-ever, very trivial, seldom amounting to more than one pennyor a few pence per case.

" By several of the returns, it appears, that on the issuingof the order of the commissioners for the allowance of extras,several of the boards of guardians, for the purpose of evadingi4 reduced the salaries of the medical officers;* others (a fewonly) gently constrained the medical officers to compound forall extras, by a small fixed addition to the annual salary;whilst others have systematically and rigorously evaded it, byperemptory instructions to the relieving officer to send all casesof accident, or cases requiring surgical operations, to thehospitals to which the board subscribes. This is much com-piained of, not on account of the mere loss to the medicalofficer of the fees only, but for the injury and risk suffered bythe patient during the removal-sometimes in carts, over badroads, for many miles."The committee beg to direct a marked attention to this

fact, as illustrative of injustice to the surgeon and inhumanityto the crippled poor, practised by boards of guardians to avoidsn expenditure of a trifling fee, intended by the poor-law com-missioners as merciful to the pauper and just to the surgeon."The payments for midwifery, it will be seen, range from

10$. (never less) to 2, according to the cases, distance, &c.,but are sometimes at a fixed medium rate for all cases. Themedium rate, however, generally appears to be to the dis-advantage of the medical man."The opinions given on the several modes proposed for re-

munerating medical officers are, of course, very varied, as arealso the facts and arguments urged in their support, of whichthe following afford a very brief summary.

11 * In some unions-the Croydon union, for example-the sum paid tomwdcal officers, including extras, was even less in amount than the salariesOlaginally paid to them.

I " In regard to the first mode, (payment per case,) theopinions given pro and con are almost invariably expressedin the most explicit and decisive language; and there is aremarkable-a very remarkable uniformity in the answers ofall those who disapprove of it, as to the principal reason tobe urged against it-viz., that if payment per case wereadopted, the guardians, overseers, and relieving officers, intheir anxiety to keep down the expenses, would refuse ordersfor medical relief in all but the most serious and dangerouscases; and thus that the great majority of the paupers wouldbe utterly unable to procure medical relief until their sick-ness had become desperate, and entirely disabled them.

" That the few cases for which orders would be given wouldbe of the most serious, and none of them of a trivial character,which would be most unjust upon the medical officer; andthat the humanity of the medical officer would be unduly andincessantly taxed by attending upon pauper cases, which hewould with reluctance see perishing for want of medical aid,but which he must administer at his own expense.

" On the other hand, those who approve of this mode urge,that under it there would always be some proportion betweenthe work done and the remuneration to be received; that itis the least complicated plan, and, therefore, likely to bemost satisfactory to the guardians, ratepayers, and medicalofficers : and a few (though but a few only) congratulatethemselves that it would save their attendance upon a greatnumber of trivial cases, and cases not strictly pauper cases,with which, under the present system, they complain theyare inundated.

" 2nd. In regard to the second proposition, there are manywho approve of a fixed salary; but who express a doubtwhether it should be based upon the number of cases attendedand the mileage, or upon those data in connexion with others-for instance, the relative numbers of the permanent andcasual paupers. Several suggest a fixed salary, based uponthe number of permanent paupers at the beginning of eachyear, with so much per case for all additional or casual casesoccurring during the year; others approve of the applicationof this mode to town districts, but deem it inapplicable torural districts of great extent, and with a scattered popula-tion ; others, again, approve of the system, but doubt the prac-ticability of fixing a rate of mileage-some suggesting so much(3d. to Is.) per mile for each case, or for each visit; whilstothers (and they appear to be by far the most intelligent, andthose who have most reflected upon the subject) suggest thatthe salary should be fixed at so much per case, upon theaverage number of cases attended during the preceding twoto five years, and be annually revised; and that instead ofspecific sums for mileage, the rate per case on which thesalary is to be fixed should be lowest in town districts, wherethe population is dense, and within certain limits-higher inmedium districts of greater extent and less density-andhigher still in those large districts where the population iswidely scattered and the cases few, and the expense of horsesis indispensable.

" 3rd. In regard to the payments for extras, almost all aresatisfied with the amounts allowed; but many require thatmany other cases should be included, and many complain thatthe extras are not allowed for cases in the union house as wellas out of it. Many disapprove of them, as the frequent causeof bickerings between the medical officer and the board;others approve of them, as affording an inducement to themedical officer to keep up his anatomical and surgical know-ledge, instead of sending his cases to hospitals.

" All, I believe, without any exception, stipulate that mid-wifery should be considered an extra.

" In reference to a fixed salary, based upon the populationand area, to be settled by the commissioners, many of thosewho disapprove, urge that the character of the population,whether greatly pauperized or otherwise, is a most essentialelement, and that the mere number and area would afford noadequate data on which the salary ought to be based. Manyobject to the commissioners having to fix the salary, as not

possessing the requisite knowledge, or a due appreciation ofthe duties, &c.; others think they are decidedly the fittestparties, and from their liberality, in regard to the extras, haveconfidence in their judgment; and all who express any opinionon the subject greatly prefer the cormni88íoners to the boards ofguardians."A considerable number, however, volunteer a suggestion,

that the salary should be fixed by and under the advice of amedical officer or board connected with the poor-law commis-sioners ; others, that there should be district inspectors underthis officer or board; that they should be appointed and paid bygovernment, and that their duties may be advantageously com-

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bined with certain others pertaining to the sanitary conditionof their localities."The document from which the foregoing extracts have been

made, taken as a whole, furnishes much material for legislativeinterference.Many of the committee’s sittings have been occupied in pre-

paring and discussing various plans for the better administra-tion of poor-law medical relief, based upon the returns justalluded to.The resolutions or suggestions agreed to by the committee,

for presentation, with a memorial, to Sir George Grey, werearrived at, after various amendments and much laborious exa-mination of different opinions.

This memorial suggests to the minister the following headsof a scheme for carrying out the objects desired :-That in the opinion of your memorialists, it is essen-

tial that the payment of medical officers should be by a fixedsalary, exclusive of fees for midwifery and important surgicalcases.

2nd.-" That the amount of salary might justly be fixed,either by an estimate of the average of cases attended duringa series of past years, considered in connexion with the areaof the medical district; or by the payment of a certain sumper head on the population, corrected by the consideration ofthe relative density and poverty of the district.3rd.-" That making every allowance for the difference

which must exist in the remuneration of private and publicpractice, it would not be just that the salary should be basedon a less amount than 6s. 6d. per case, with the charge vary-ing with the area.

4th.—" That medical officers of workhouses should be paida separate salary, based on the average number of inmates, atnot less than Ts. to 10s. per head.

5th.-" That it is just and proper, and conducive to the in-terests of the poor, that an extra payment should be made, asat present, for midwifery and for important surgical cases; andthat it appears to your memorialists advisable that the feesshould be paid for cases occurring in workhouses, as well as inout-door cases.

6th.-" That to the cases of surgery requiring payment, enu-merated in the General Order of the Poor-law Commissioners,should be added,-

Fractures of the clavicle.Fractures of the skull.Retention of urine, when requiring repeated introduction

of the catheter.Severe burns and scalds.And that X3 be paid for compound fracture of the arm.

7th.-" That the payments allowed for midwifery and sur-gical cases under the General Order of the Poor-law Commis-sioners are satisfactory in amount.8th." That in order to remove difficulties in the way of a

more equitable payment of medical officers, and consideringthat half the union medical expenses are already paid fromthe consolidated fund, it is highly desirable that the wholeexpenses of the medical attendance on the poor should beremoved from unions to the consolidated fund.

9th.—" That it is expedient that there be a director-generalof the poor-law medical department appointed by govern-ment, and exercising supervision over poor-law medical prac-tice, in the manner of the other public services.

10th.-" That it is expedient that there should be inspectorsgeneral of poor-law medical practice appointed by govern-ment, and acting under the orders of the director-general.

llth.—" That the inspectors general, acting each in a dis-trict assigned to them, should examine the infirmaries of work-houses, inspect the reports of the medical officers, inquire intocases of alleged negligence, &c. &c., and that matters of dis-puted payment should be referred to them.l2th." That the medical officers of unions should be ap-

pointed by boards of guardians, as at present, subject to theapproval of the director general ; that their qualificationshould be as at present ordered, but that all future modifica-tions of the qualifications should be made by the director-general.

13th.-" That the appointments of all medical officers shouldbe permanent,-that is, to endure until they die, resign, or aredismissed for some valid cause.14th." That the forms of books or reports should be ap-

proved by the director-general, and should be as short andsimple as is consistent with the requirements of the publicservice.

15th.-" That the access of the paupers to the medicalofficers should be made as ready as a due distinction betweenthose who require parochial attendance, and those who do not,

will admit. That in doubtful cases where illness exists, andthere appears to be temporary destitution only, the board may

grant medical relief by way of loan; that in such cases a fee

of be paid by the board of guardians to the medicalofficer." Signed in behalf of the Committee,

THOMAS HODGKIN, M.D., Chairman.4, Hanover-square, March 26th, 1848.

At this period the attention of the committee was turnedto the consideration of a series of resolutions proposed byLord Ashley in the House of Commons, for the better ad.ministration of poor-law medical relief. An interview havingtaken place with his lordship, in order to discuss the subject,and certain alterations having been agreed to by Lord Ashley,at the suggestion of the deputation, coupled with other expla-nations, the following resolution was adopted :-"That the committee, though convinced that more is needed

to effect all the improvements required in the system of poor-law medical relief, dees hereby pledge itself to give its aid toLord Ashley in carrying such resolutions, and recommendsthem to the active support of the poor-law medical officers,and of the profession."The committee consequently suspended the publication of

their resolutions, and the final consideration of the memorialto Sir George Grey, until Lord Ashley’s motion had been dis-cussed in the House of Commons; in the interim, communi-cations were made to the Colleges of Physicians and Surgeons,and to the Society of Apothecaries, soliciting them to peti-tion, respectively, the House of Commons in favour of LordAshley’s motion. Mr. Wakley was also asked to oblige thecommittee by giving his support to the measure in his placein Parliament. Nearly a month, however, elapsed beforeLord Ashley had an opportunity of bringing forward his re-solutions in the House, which being lost, though ably pressedby Lord Ashley, and warmly advocated by Mr. Wakley andother members, the committee again pursued their originalcourse. It was forthwith agreed that the memorial and reosolutions, as finally revised, should be immediately sent to theSecretary of State for the Home Department.The committee still feeling the importance of actively

, pressing their cause in all available quarters, judged it wellto employ the interval in obtaining an interview with thepresident of the poor-law commission. The time was favour-able for this step, as the subject had so recently been before

, him through Lord Ashley’s resolutions, which he had some-what sweepingly opposed, and as it was again to receive at-tention through the promised audience with the Home Secre.tary. The resolutions of the committee were prepared, and

. it was no longer barred from agitation by delicacy to Lord

. Ashley. The result of this interview has already been pub.lished.

Helative, however, to the interview with Mr. Huller, thecommittee draw attention to the statement which he made,after promising to try to improve the medical entry books,that it was his intention, immediately after the rising of Par-liament, to take up the whole question of poor-law medicalrelief, with the hope of adjusting what he already felt was themost difficult part of all his responsibilities. This statementand admission may be taken as evidence of the excitementthe matter has made in the right quarter, which must not belost sight of by the poor-law medical officers, whose unpro’tected and precarious interests demand unremitted and vigilantattention till a satisfactory amendment of the present systembe adopted. Another motive is here furnished for collectingimportant facts, and duly placing them before the notice ofthe committee, that they may be brought to bear on the poor-law board in the most effective manner, not merely directly,but also indirectly, through the strength of public feeling.

Sir George Grey assured the deputation of the interest hefelt in the matter, although the subject more immediatelybelonged to Mr. Buller, with whom he would confer upon it;he also said that the question of expense was subordinate towhat was necessary to secure efficient medical relief. Therecan be little doubt of the money question being, after all, thegrand difficulty to be overcome; even Mr. Buller smilinglyremarked to the deputation which waited upon him to urgethe appointment of a medical board and inspectors, that hefeared the deputation took the same view of the consolidatedfund that was fashionable in the House of Commons; it was,unfortunately, not so inexhaustible, and in the present day,less so than usual; but he inclined to consider medical reliefa question distinct from ordinary poor-law administration, andone which should be put on a separate and more comprehen-

sive footing. It is obvious that important changes in this de-I partment will, ere long, be brought into operation. How far

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these will work well for the remuneration and position ofthe medical officers will mainly depend upon the animus ofMr. Buller; hence the necessity for the utmost vigilance andexertion on the part of the committee and convention, thatthe president may take no false step in well-intentioned effortsto ameliorate the present system of poor-law medical relief.

It will be borne in mind, that towards the close of last yearcircular letters, requiring much information on the prevalenceof disease and other sanitary matters, were issued to the unionsurgeons by the metropolitan sanitary commissioners. As noremuneration was attached to answering these letters, whichwere addressed, as was the case on a former occasion, topoor-law medical officers, it was deemed right by the com-mittee to seek an interview at Gwyder House on the matter.Lord Robert Grosvenor (president), with the other com-

missioners, gave a lengthened audience to the deputation, andadmitted, in general terms, the grievances endured by poor-law surgeons, but felt that no power was furnished by theircommission to interfere in the matter, or grant any paymentfor past services which the sanitary question had received atthe hands of the medical gentlemen acting under the poorlaw. It was felt needful to seek this interview, as tending tomark the sense of the committee that these, and similar un-requited demands on the time and knowledge of medical menfor public objects, however laudable in themselves, are quiteforeign to the official duties of union surgeons.

Various cases of general importance to the administrationof medical relief, and to the poor-law medical staff moreespecially, have been watched by the committee, in some in-stances even investigated, and in all treasured up with a viewto their ulterior bearing on the subject. The committee haveoften noticed an improved feeling in regard to their claimsas evinced by boards of guardians, and more especially bythe authorities of Somerset House. Illustrative of this maybe cited the augmentation of the salaries of the medical offi-cers of the Holborn and other unions.

Nevertheless it has been most painful to witness such in-stances of injustice to medical officers as have been furnishedby the Croydon and Huddersfield cases, and the marked hos-tilitv of the Chesterfield Union.Soon after the meeting of the convention, it was suspected

that intimidation was used to prevent the free action of medi-cal officers, which was confirmed by the circular letter of theChetterfield Union. The committee lost no time in callinggentlemen so assailed to a steady, yet temperate, perseverancein their objects-urging the high character of their enter-prise, and the unworthiness of all who used any unfair mea-sures to impede its progress, as well as of those who succumbedto such influence.The judgment given in a higher court than a coroner’s, has

shown, in the notorious Croydon case, at how low an estimatethe dictum of a jury inflamed against a union surgeon shouldbe held by dispassionate men; yet the verdicts recorded atsome inquests have shown a favourable disposition on thepart of juries.Mr. Tatham’s case at Huddersfield is another happy illus-

tration of a temper in high quarters eminently friendly tothe interests of the poor law medical staff.The committee strongly advise publicity to be given in

every instance of injustice or suffering traceable to any mal-administration or defective provision of the present systemof poor law medical relief.Although the committee, on a retrospect of their exertions,

cannot point to much advantage secured, the review is by nomeans discouraging. Attention is more than ever alive to thesubject. For the first time, the poor-law medical staff hasspoken out, unå voce, their deep sense of their grievances, theirfirm, temperate resolve to seek, and by perseverance to

obtain, redress. Not their appeal alone, but the encouragingvoice of the whole profession, as raised by the Colleges ofPhysicians and Surgeons-by the Apothecaries’ Society-andby other medical associations, has been addressed in supportof the objects of the convention, both to the Home Officeand to the House of Commons.Let it be prominently borne in mind, that the great body of

the rate-payers who elect the local guardians, and influencepowerfully the legislature of the country, are indifferent onthe subject chiefly through ignorance of the wide-spread evil.Every medical officer, and every disinterested, philanthropicmember of the profession, should use time and argument toinform and influence his friends and patients ; particularlyshould this be done towards such gentlemen as have seats inthe House of Commons, that they may be able to agitate andadvocate the question as one of national policy and honour,as well as of justice and benevolence.

It is believed that some medical officers have hesitated toavow an attachment to the convention through their peculiarposition with local boards; such, at least, while they rememberwhich is said to be " the better part of valour," should notforget what " are the sinews of war," and remit, accordingly,subscriptions for the past as well as for the current year,that the exertions of the committee may be continued un-imnaired.

TIIO-4AS HODGKIN, M.D., Chairman.CHARLES F. J. LORD, Hon. Secretary

TREASURER’S REPORT.Committee of Poor-law Medical Officers in account with the

Treasurer.

I Further subscriptions are respectfully solicited, and it isparticularly requested that gentlemen remitting subscriptionsby post-office order, will be pleased to make the same payableto the treasurer, Thomas Martin, Esq., Reigate, at the post-office, Reigate, Surrey.

Correspondence.

UPTON-UPON-SEVERN UNION.

" Andi alteram partem."

To the Editor of THE LANCET.SiR,łWe beg to hand you the enclosed advertisement,

just published by the Upton board of guardians. We wouldobserve that the present constitution of the districts differsmuch* from the old arrangement-that district No. 1 nowcontains 18,020 acres; and district No. 3, 16,040; in bothwhich the general order of the poor-law board, with refer-ence to medical appointments, has been violated, that orderhaving prescribed 1500 acres as the maximum extent of amedical district. We have laid our case before the poor-lawboard, but have, as yet, received no reply. We understandthat for some time past several men have been canvassingfor the vacant districts.We will continue to report to you, from time to time, the

progress of events.With best thanks for your very able and energetic ad-

vocacy of our cause, we remain, Sir, your obedient servants,

T7ntnn.nn_Severn_ Tnlv. I R4fLCHAS. BRADDON.W. T. WHITE.

" Upton-upon-Severn Union.-To the 1Jfedical P1’ofession.-The board of guardians of Upton-upon-Severn will, at theirmeeting to be holden on Thursday, the third day of Augustnext, proceed to the election of a medical officer for each ofthe following districts of this union. Medical gentlemen,duly qualified to practise, and willing to undertake the dutiesof either of these districts, are requested to make applicationsin writing to the board, (accompanied by certificates of quali-fication,) before ten o’clock in the morning of the third day ofAugust next, and to attend personally at the board-room byeleven o’clock on the same morning, when and where theelection will take place.

District No. 1 comprises the parishes of Earl’s Croome,Hill Croome, Hanley Castle, Little Malvern, Ripple, Upton-upon-Severn, and Welland, with the hamlets of Holdfast andQueenhill. Salary, X83 per annum.

District No. 2, the workhouse at Upton-on-Severn. Salary,X20 per annum.

District No. 3 comprises the parishes of Berrow, Birts-morton, Bushley, Castlemorton, Eldersfield, and Longdon.Salary, £70 per annum.

District No. 4 comprises the parishes of Croome D’Abitot,Kempsey, and Severn Stoke. Salary, X40 per annum.