954

but had undergone some change. The co-

agulum formed in aneurysmal sacs was

never found to contain vessels, although thesac was carefully injected after death.

Mr. DALRYMPLE was perfectly aware,with Mr. Meade, that blood effused by thedirect rupture of vessels, either in fracture

or ordinary contusions, was usually ab-sorbed. The peculiarity in the case relatedconsisted in the organisation of the effusionin a case of extreme cachexia. He believedthat this fact would be found applicable tomost cases of inflammatory effusions occur-ring in cachectic states of the system. Inanswer to Mr. Arnott, he might remark,that he had guarded himself, in the com-mencement of the paper, against verbal criti-cisms, by stating that it was either fibrin orthe organisable materials of the blood thatbecame vitalised bv new vessels, under thecircumstances described. Although he couldnot pretend to say that the coagulum inquestion consisted of pure and healthy blood,it was such as was circulating in the vesselsof a person affected with scurvy; and whenit was remembered that this coagulum hadbeen kept for several weeks in spirit of wine,the colour and consistence it at present re-tained, would be found to argue strongly infavour of its being a genuine coagulum ofblood. The preparation was in the posses-sion of Mr. Busk, of the Dreadnought, whowould willingly exhibit it to any member ofthe profession. An inspection of it wouldremove any doubts as to the real nature ofthe effused substance.

Mr. LISTON said that the injections of

Ianeurysmal sacs had not, as yet, been madewith minute materials, but merely with theview of showing the larger anastamosingvessels, neither were they examined in amanner which was likely to lead to a know-ledge of the true condition of the coagulum.Future and more accurate examinationsmight yet detect the layers next and adhe-rent to the sac to be organised.The moment the President had adjourned

the Society, Mr. JULIUS JEFFERYS rose, andtaking from his pocket a handful of pam-phlets, proceeded to address the memberson the qualities and properties of opium,chiefly to prove, it would appear, from thefew words we heard, that it is an " unneces-sary stimulus" to the Chinese. The mem-bers did not seem disposed to listen to theunexpected address, and the room was soonempty.

PUBLIC HEALTH.-On the motion of Mr.Slaney a select committee of the House ofCommons has been appointed to inquireinto the circumstances affecting the health ofthe inhabitants of large towns and populousdistricts, with a view to propound sanatoryregulatiuns of health.

THE LANCET.

London, Saturday, March 21, 1840.

PAROCHIAL MEDICAL RELIEF.

IT was shown in the last LANCET that therate of payment under the new regulationsof the Poor-Law Commissioners, is one shil-ling and five-pence farthing per case in themetropolis, and three shillings and three-pence, half-penny in the country districts; while thecost-price of efficient remedies, without rec.koning anything for the trouble of compound.ing them, anything for journeys, or anythingfor advice, would amount to three shillingsand six-pence per case.

There is another mode of calculating the

expense of drugs and medicines. If we take

an hospital containing 100 beds, and thebeds be always occupied by patients, whatwould be the cost-price of medicines for ayear ? In the 9 county hospitals which wereenumerated in a former article, the drugs forthe patients in 100 beds cost £ Z99 a-year,that makes very nearly R3 to each bed, or toone patient a-year ; in the Bristol Infirmary,

it was:e31s; in St George’s Hospital, 413s;and in nne eniint.-v hospital. f5 1 h. It is

evident that the cost-price of medicines for100 patients, constantly on the books of a

Surgeon, will amount to the same sum, whe-ther they be collected in an infirmary or

scattered over an extensive district. The

drugs for 10 patients on an average on theSurgeon’s books would cost at least £ 30 or40. It appears, from the ParliamentaryReturns, that for attendance on 10 constantlysick, the Surgeons of Unions are paid 20year in the metropolis; f21 in Devonshire;;t22 in the districts of Wiltshire; JE23 in

Sug ,Ik; 0 g29 in Dorsetshire; f30 in Lin-

colnshire ; £31 in Cheshire and Lancashire;and £ 39 in Norfolk: in the districts of the

8 counties collectively, JE26 10s., or a sumconsiderably less than the cost-price of reme-

dies.The result by this mode of calculation de.

monstrates as decisively as the payment per.

955PAROCHIAL MEDICAL RELIEF.

case, the miserable and inadequate rate of

payment, under the present system, of whichthe Poor-Law Commissioners claim the

paternity or maternity, or, at any rate, the

godfathership.The payment for medical attendance on

paupers has been compared with the cost-

price of medicines in hospitals and dispen-saries. In the evidence before the Parlia-

mentary Committee, it was also comparedwith the rate of remuneration for medicalattendance upon prisoners and felons in

gaols. It was ascertained from the Annual

Return made to the Secretary of State forthe Home Department, that in 1832 the

number of cases of sickness in 80 Englishprisons was 8697; and that the salaries ofthe Surgeons amounted to f:5913. Hence

it appeared that the remuneration for medi-cines and attendance upon a case of sick- Iness in a felon, was 13s. 7d.; in a pauper,3s. 3d, if he lived in a wide county district;and Is. 5!d. if he lived in the metropolis. ’

The average population of the Englishprisons was 10,495 ; the payment for at-tendance upon a 100 prisoners a-year, was,therefore, f57 10s., or 10s. 6d, for each pri-soner. In the Irish prisons the medicine is

paid for separately, and for each prisoner itwas 7s. 6d. a-year, on an average of seven

years. In 1826 the medical attendance upon

each prisoner was 91 a-year, in addition tothe drugs supplied separately by the apo-thecaries.

To show that the Surgeons of prisonswere not overpaid, their salaries were com-pared with the salaries of the Chaplains.The Parsons are better paid than the Sur-geons : £ i12 are paid for attending to thespiritual wants of 100 prisoners; E57 onlyfor attendance on their physical wants. TheMedical salaries are, on an average, E79

a-year ; the Clerical salaries, E161. The

Chaplains do not supply books from theirsalaries, while the Medical men supply me-dicines. The average number of prisonersin the Dorchester Gaol and House of Correc.

tion was 125 in 1837 ; and the Draggist’s

bill for the year was 981 ; the Surgeon’ssalary, :S50.

One of the witnesses was asked by theCommittee-

15,841. " Have you been enabled to as-

certain why it is that the Surgeons ofgaols are so much better paid than the

Surgeons of Parochial Unions ?-I con-

" ceive that the consequence of neglecting" the prisoners in gaols has been made too" frequently evident to allow any parties to" overlook that fact; gaol-fevers and other" diseases have often attracted the attention

" of Government, and the number of deathsoccurring in the gaols is recorded, andknown to everybody. Deaths occurring" over a scattered district, and at isolated

points, are often forgotten, and make nogeneral impression. On the other hand," the Magistrates appoint the Surgeon to the

" gaols, and the Magistrates are not so dif-"ficult to deal with as the old overseers

were, and they are rather more scrupulous.« The overseers attended more to the amount

of the salary than to the efliciency with" which the duty was performed.

15,842. "And you think that the Guar-" dians are afflicted with the same evil ?-

"I think, when the Guardians are aware ofall the facts which have been broughtbefore the Committee, they will readilyfurnish the Poor with efficient medical

" attendance and medicines : I hope that

" they will."

The Poor-Law Commissioners propose to

pay by the Pauper Schedule to a certainextent. For 100 paupers put on the list, ifthey were in average health, the paymentought to be 50 guineas a-year-to be thesame as the payment in gaols.

’ For the present, we can only recommendI Medical Practitioners to be cautious in enter-

ing into any contract, at a mean, inadequate’ salary, or at a rate lower than was recom-

mended by the Medical witnesses, as theymay do themselves and the Poor incalculable

injury by a false step now, or a step not madein concert with their brethren.

3Q2

956 ARMY MEDICAL ESTABLISHMENT.

At another time we shall endeavour to which might be the Paradise of the Staff-

depict some of the disastrous consequences Assistant Surgeon, where five of that rank

that have flowed from forcing Medical Offi- have generally nothing else to do but quaffcers into the service of Unions, without their wine, smoke their cigars, and eat their

allowing them money enough to pay for beccaficoes, is in reality no such thing. Thisefficient remedies. Dr. R. D. THOMSON’S colony, which should be the resting-place ofevidence threw great light upon this matter. the worn-out Surgeon, where he might enjoy

’

__________

his " otium cum dignitate," is generally oneof the most unpleasant stations. There is

OF the complaints which have often been otium enough, to be sure, for them, but theirbrought before the public, and justly, in our dignity is sadly curtailed.opinion, of the slowness of promotion in the This laborious idleness cannot be better

Medical Department of the Army, to no illustrated than by the following dialoguebranch of this service will these remarks that occurred between the Principal Medicalmore forcibly apply than to the Medical Officer and a Staff-Assistant Surgeon, whoOfficers of the Staff. The Regimental Sur- had just landed on the Rock. "Do you

geons, however arduous their services may "know who I am, Sir?" said a late Medicalbe in foreign and unhealthy climates, not- Chief. "I have not the least idea,"withstanding the poor remuneration they answered the junior. "I am the Deputymay receive for them, have always the com- "Inspector-General of Hospitals." ‘ Sir,forts that attend a well-directed regiment, "then to you I am to give my letter of

and the cheering support of their Command- ‘‘ service ; and I am directed to put myselfing Officer, when justly merited; but the "under your command, and to learn the par-poor Staff-Assistant Surgeon is an insulated ticular duties I am to perform."-" Oh,being, sent, on the slightest emergency, at "those, Sir, I can soon explain. You are

half an hour’s notice, to the most distant "come here to assist four other young gen-

quarter of the globe, the probable seat of tlemen to do nothing, and part of my dutysome then-existing epidemic. He is at con- is to superintend you all, and give you anysiderable expense for outfit, and often suffers "assistance you may require."great personal inconvenience by being sent To explain this state of things in a fewon such a sudden mission. When arrived at words, it will merely be necessary to men-his destination, without friends, without the tion, that the Government granted this largecomforts of a regimental mess, living se- Medical Staff to Gibraltar to watch over the

cluded, perhaps in his hospital, he is sup- general health of the inhabitants, and to be

ported alone in the zealous discharge of his on the spot, should any of those epidemicsduties by a high sense of honour, and truly arise which visit Gibraltar from time to

fortunate will be his lot if, after years of time. This arrangement appears reasonable

tropical service, he can return to his native enough at the first blush, but is quite theclimate without having his constitution per- contrary when closely examined, and visits

manently impaired. But though this be the the Staff Officer with great hardship. By thegeneral lot of Staff-Assistant Surgeons, yet excess of humanity the Assistant-Surgeon isthere are a few select stations where the made to be at the beck of every inhabitant of

favourites of fortune, or of the Director- the garrison, at every hour, day, or night; noGeneral, have no such hardships to endure. matter how trivial the case may be, he mustOf these very few’happy localities, Gibraltar hurry to attend the call of the troublesome

may perhaps bear the palm, where the and often insolent few. Let the reader

salubrity of the climate and the general fancy a young Staff-Medical Officer, who,health of the garrison call but little on the willing and anxious though he be to

exertions of the Medical Officer. This, then, attend his medical duties, is not without a

957FATAL YEARS OF LIFE.

share of reasonable vanity, and feels no

small complacency in carrying his longsword lightly suspended by his sling belt,his grave and respectable cocked hat, hisred coat, simple without over-ornament, hisblue trousers, not forgetting the red stripe :let the reader, I say, suppose this young

officer, not a little proud of such display,called to go armed thus cap-à-pie, to be pre-sent at the accouchement of some great un-washed Rebecca,—When any aged Spanishmatron would be fully as efficient, and wouldfeel she had no military dignity to degrade.

If his attendance were necessary in these

cases, the medical officer, for humanity sake,would cheerfully submit to it, but it is not

so. It is well known that there is a largecivil hospital at Gibraltar, to which everyinhabitant has ready admission. Advice is

daily given gratis by two Civil Surgeons, andmedicine to those that require it. Besides,if this be not sufficient, it can be proved thattwo of the many intelligent Civilian Doctors,one English, the other Spanish, would giveample medical relief out of doors, for a smallannual stipend, whenever there was reason-able objection to the removal of the patientto hospital. By adopting this plan, a

saving 01 £800 at least would be maae to

the country, and the duty would be better

done, because it would be more agreeable to

the feelings of the inhabitants; and instead ofsuch a large store supply of Medical Officers

against any epidemic that might arise (who,in the interim, are apparently busily, butreally idly occupied), the steamer, in 10 or 12days, would bring any number of Surgeonsfrom England the emergency might require.To conclude, if these remarks lead to an

alteration of this mistaken system, they willnot have been made in vain; but if, likemany other abuses, they have become toorooted to be removed, all we can do is tocongratulate the poor Spaniards of Gibraltaron the superfluity of Medical and MilitaryDoctors at their command, and, above all,to praise the divine benevolence of thepresent system, which undervalues the easeof the Medical Officers of the Staff when theimaginary convenience of any Spaniard isconcerned.

THE STATISTICS OF AGES.

HENRY COLES.

To the Editor of THE LANCET.SIR:—I have just seen your Number for

Feb. 15 of the present year. In it appearsome "Remarks on the more Fatal Years ofLife," forwarded by Mr. Slight, of Ports-mouth, the compiler of which finds, fromthe Regi:3trar-General’s Report, " that morepeople die at the ages of 30, 40, 50, 60, and70, than either in the year before or the yearafter," and gives a table to illustrate thispoint, which affords results that, he says,will" open a large field for medical andsurgical inquiry." Before entering on thisfield it may not, perhaps, be impertinent tosuggest one or two queries. 1st, What isthe fair allowance that ought to be madefor the natural aptitude to give round num-bers which people so universally evince?

2ndly, Suppose a person dies soon after hehas attained the age of 49, or a little beforethe age of 51, is it not probable that hisfriends would give in his age as 50 to theDistrict-Registrar; and would not the fre-quency of such an occurrence go far to ac-count for the disparity apparent in the

Table ? 3rdly, Is it not observable that

many people show a strange tenacity in

sticking to certain round numbers whenallusion is made to their age; and, in popu-lous districts, does it not often occur thatsame of the lower orders have really for-

gotten their age, and, having migrated fromsome distant place, cannot easily ascertainit, and therefore find it most convenient to

speak of their ages by tens ?For nearly three years I have kept a

register of the ages of women applying forrelief from a large lying-in institution inthis town, and from my Tables I shouldconclude that the ages of 30, 35, and 40,

were most remarkably prolific parturientepochs, did I not make a large allowancefor the heedlessness and inattention of the

patients. Most certainly it never entered; into my head to enter on any physiologicalinvestigation to account for this fact. I am,

Sir. vour obedient servant.

Cheltenham, March 11, 1840.

To the EditO1’ of THE LANCET.SIR:—In a late Number of THE LANCET

I perceive a communication from a gentle-man at Portsmouth, containing the remark-able statement, founded on the first AnnualReport of the Registrar General of Birt6stDeaths, and Marriages, viz., that more

persons die at the ages of 30, 40, 50, 60, and70, than either in the year before or in theyear after those numbers. Now, I begleaveto make one or two short remarks on theabove. In the first place, the observation,that the decimal years of life are the mos