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A.M., when she gradually became unconscious; and, when seenby Dr. Woodfall, at four o’clock P.M., was in a state of pro-found coma. The measures resorted to for her relief were ofno avail, and she died at three o’clock the following morning,nineteen hours from the commencement of the attack.The head was examined thirty-six hours after death. Thesubstance of the brain was wounded in removing the calva-rium, and a considerable quantity of blood flowed out. Onthe surface of the left hemisphere two thin plates of bone werefound, of small size; and in the superior longitudinal sinuswere two others, about an inch in length, and one-sixth inthickness, at the thickest part. The substance of the brainwas generally soft. The floors of the lateral ventricles werestained with blood, which had filled them, but which hadmostly escaped in opening the cranium. The softening wasmost marked in the posterior corner of the right ventricle,and in parts presented almost the appearance of pus.

DISEASE OF THE HEAD OF THE THIGH-BONE.

Afr. HENRY SMITH exhibited two specimens of the upperextremity of the femur, consisting of the head and trochantermajor, which had been removed from the living body by opera-tion ; the one by himself, and the other by Dr. Morris, ofSpalding. Although the specimens indicated the same dis-ease, they differed materially in some respects, and Alr. Smithexhibited them for the purpose of showing the pathologicalchanges which take place in the head and neck of the tliigli-bone in hip-disease, and how they differ according to thelength of time the disorder has existed. In the one case,when he had removed the bone, the disease had not existedmore than two years: here the head of the bone was com-pletely carious, but it retained its globular shape, and theneck of the bone was neither altered in its structure, nor wasits natural relation to the shaft destroyed. The other specimenwas that from a youth who had had hip-disease for six years:here the head of the thigh-bone had completely lost itsglobular shape, was flattened out widely, and the neck of thebone was much absorbed; and instead of being at an obliqueangle with the shaft, it formed a right angle with it. Mr.Smith did not bring forward these specimens for the purposeof arguing about the propriety of the operation of excision ofthe head of the femur, as that was now a settled question,but merely with the object of showing the pathological differ-ences in the bone, so beautifully marked.

Dr. LANKESTER read a paper on

FUNGOID DISEASE OF THE BLADDER, AND ITS DIAGNOSIS.

The author’s attention was directed to this disease, and itsdiagnosis, by the following case:—A gentleman, sixtv-twoyears of age, was suddenly attacked, whilst working in hisgarden, with pain in his back, which was followed by the ex-pulsion of some bloody urine. The pain in the back conti-nued, with the bloody urine. He had recourse to medicaladvice, but at the end of a twelvemonth he was no better:the pain in the back continued; there was also pain referredto the neck of the bladder, and shooting pains down thethighs. He had suffered for many years from dyspepsia,

which was now very much increased. He had consultedseveral physicians and two surgeons at different times; andthe sound had been passed several times, without a stone

being discovered in the bladder, and with the effect of pro-ducing great pain and an increase of blood in the urinarysecretion. There was frequent desire to make water. Thewater passed was now sometimes bloody, and sometimes com-paratively clear. It was acid to test-paper. On cooling, anorganic deposit, with lithate of ammonia, occurred. Theorganic matters consisted of shreds of mucuiill pus, and blood-globules. Albumen was precipitated by heat and nitric acid.No stone having been detected by sounding, the general symp-toms of disease of the kidney being absent, and the haemor-rhage evidently proceeding from the bladder, and the urinecontaining mucus, pus, and blood-globules, the case was treatedas one of chronic inflammation of the bladder, with ulceration.With rest and sedatives, and afterwards copaiba, the patientimproved, and removed into the country. He again consulteda surgeon, who recommended the passing the catheter, and in-jecting the bladder. This was followed with increased bleed-ing, great pain in the back and over the pubes, and constantdesire to pass water. Diarrhoea and vomiting came on,and he rapidly sunk, eighteen months after the first attack.On examination after death the left kidney was found doublethe natural size, and greatly congested. The right kidneywas enlarged, and presented patches of granular generation.Both pelves were congested, and contained puriform matter.

The ureters were congested. The coats of the bladder werethickened; the prostate enlarged. A loose mass, of a yellowishcolour, was found in the bladder. Seated at the funduswas a small tumour, vascular and red in the centre, andyellowish at the sides. Another larger tumour presenteditself on the side of the bladder above. These tumours re-sembled each other, all of them affording evidence of en.cephaloid, combined with fungus hsematodes. Vascular

spots, similar to those in the bladder, were found in the pros.tate. The author drew attention to the difficulty of the dia-gnosis of malignant disease of the bladder. Neither thepresence of blood in the urine, nor its persistence, was alonesufficient to determine the case. He believed the microscopepresented the best means we possessed. The presence of thepeculiar nucleated and fusiform cells of carcinoma were asure indication of the presence of malignant disease. Hereferred to three cases, in proof of this position. The absenceof these cells, though not always conclusive, was yet verygenerally indicative, of haemorrhage from the bladder, arisingfrom some other source. In the treatment of these cases,where the malignant disease was made out, great care shouldbe taken not to introduce instruments into the bladder unne-cessarily, as the fatal result must be hastened by such prac-tice. Sedatives, more especially opium and astringents, asgallic acid, acetate of lead, and sesquichloride of iron, werethe principal remedies.

blr. COULSON related a case of medullary sarcoma of thebladder, and exhibited a preparation. In this case, whichoccurred some years ago, great pain and suffering had followedthe introduction of the sound. He thought that careful exa-mination of the urine by the microscope would be the bestmeans of discovering the nature of these diseases.

llr. 1-1. WALTON referred to a case of disease of the bladder,attended with haemorrhage, in which the urine was carefullyexamined by Dr. G. 0. Rees, but nothing was found to indi-cate carcinomatous disease, which was found to be veryextensive after death.Mr. NUNN said that he had attended a case of disease of the

prostate with Mr. Simon, in which that gentleman had dia-gnosed carcinoma from the presence of the nucleated andcaudate cells in the urine.The PRESIDENT drew attention to the importance of using

means for the arrest of haemorrhage in these and similar cases,which was sometimes very difficult to arrest.Mr. KESTEYEN had attended a case of fungus of the bladder.

Stone had been suspected, and the patient was sounded bytwo eminent surgeons. In this case the bleeding appeared tobe arrested by the administration of the tincture of sesqui-chloride of iron. Between the haemorrhagic periods the urinewas quite clear, and free from albumen.Mr. HANCOCK agreed with Dr. Lankester as to the impro-

priety of introducing sounds and catheters in these cases; whenonce the disease was ascertained to exist, perfect rest andthe administration of sedatives should be had recourse to.Dr. SmsoN recommended the administration of belladonna

in cases of malignant disease. He had found it relieve effec-tually every pain to which the body was subject, independentof derangement of the brain. The dose he gave was half agrain night and morning, gradually diminishing the dose.

Dr. DANIELL suggested, that as the urine was mostly alka-line in cases of stone, and that it was acid in the cases related,it would probably assist in the diagnosis of diseases of thebladder.Mr. GOWER had seen very great benefit derived, in all cases

of disease of the bladder, from the taking into the system largequantities of gum.

CONVENTION OF POOR-LAW MEDICAL OFFICERS.

As the opening of the present Session of Parliament drewnear, the committee addressed a letter to M. T. Baines, Esq., M.P.,the President of the Poor-Law Board.

After pointing ont the grievances of the medical officers, whichare already too well known to the profession, the Committeeconcluded their letter to the President thus :-

" Prior to the opening of another Session of Parliament, wewould respectfully inquire if any, and what, measures of redressyou may have been able to project or mature, with the poweralready vested in your hands.

" Should you still consider these powers so limited as to pre-vent you from carrying out remedial measures, we would seekyour suggestions, and hope for your co-operation in obtainingfrom Parliament an improved position for the Poor-law MedicalStaff, and more applicable means of succour for the sick poor,"

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The receipt of the letter having been acknowledged with merelyan official statement that " the Board would take the subject intotheir consideration," it was judged expedient to seek an interviewby deputation, that the important subjects adverted to in theletter, with others relating to union surgeons, might be discussed,and that the opinion and proposed line of action of the Poor-LawBoard being ascertained, the future course to be adopted by theCommittee might be better defined.

Subsequently, a deputation, of which Dr. Hodgkin, Dr. Bar-nett, Mr. Liddle, and Mr. Lord, were members, attended at thePoor-Law Board, and had a long interview with Mr. Baines, thepresident, and Lord Ebrington, the secretary. The subjectmatters of complaint having been fully and clearly stated by themembers of the deputation, the following is the Report which hasbeen sent to us of the remarks which fell from the president andthe two secretaries, Lord Ebrington and Mr. Nicholls, the last ofwhom was a former commissioner.The PRESIDENT considered that he must in some degree have

been misunderstood on the former interview, respecting thepower of the Board, he was quite aware of that; and on manyoccasions it had been exercised favourably respecting the salariesof the medical officers; but with respect to cholera and otherepidemics, the Poor-Law Board had not the power to lay downany prospective scale of remuneration for extraordinary services,but the power of granting a reasonable compensation on accountof such services was vested in the guardians, and that wheneveran increase was proposed, the Board had always much pleasurein confirming it. The general question of Poor-Law MedicalRelief, with the scale of remuneration, was so beset with diffi-culties, owing to the discrepant interests of the parties concerned,that it appeared more and more difficult of adjustment the moreit was looked into. The Board had no power to interfere, andorder payment for such services as the Board of Health required,- the guardians had, however, by the proviso to art. 172 of theGeneral Consolidated Order.

Mr. NicHOLLs feared that if medical relief were rendered gra-tuitous to all, it would be open to much abuse, and throw greatresponsibility on the relieving officer.

Lord EBRINGTON said, even now, where there is no fixedsalary, a lax board of guardians and a lax relieving officer oftenplace many more cases under the care of the union surgeon thanthe real poverty of the applicants render necessary.

It was stated that the gravamen of the complaints of the unionsurgeons rested upon the fact that there was not a fixed standardof payment for medical services.

Mr. BAINES inquired what plan the Committee proposed forthat end?

It was replied that there was a very general opinion in theprofession, and that it was assented to by the old Poor-LawCommission, that an average payment of 6s. per case throughoutthe country would be an adequate payment. The Committeehad anxiously deliberated on this subject, and believed that thesum named was a tolerably accurate approximation to a fairstandard of payment.

Lord EBRINGTON inquired by what means it was understoodthat the value of a case could be determined?

It was explained that the two elements in constituting thevalue of a case, were population and area.A discussion afterwards took place upon the mode of striking

a scale of payments upon the elements of population and area.It was then asked whether the Board had it in contemplation

to bring forward any measures of redress during the presentSession of Parliament.The PRESIDENT replied that he was not in a condition to

make any pledge that he had.It was then stated that it was very generally understood that

the Poor-Law Board were preparing a Bill providing for asuperannuation fund for union officers.The PRESIDENT observed that it was true such a measure had

been in progress, but that he had not yet seen it. It was notintended, however, to embrace the medical officers within itsprovisions.

Lord EBRINGTON stated the principle of the Bill was that oflevying a per centage upon the salaries for the purposes of afund, and was of the nature of an insurance, on the same principleas was acted on in the Treasury and other offices.A hope was then expressed by the deputation that the Board

would devise a means of enabling the medical officers to receivethe advantages of such a fund if they should so wish, by admittingthem to it as members, at their option.Mr. NICHOLLS remarked, that this view had suggested itself tc

them, and promised that consideration should be given to thesubject.

In reply to a question from Mr. Nicholls, as to the mode in

which salaries should be computed for unions, it was stated, thatthe basis of calculation being determined,-namely, population,and number of cases a’.tended, (on an average of three years,)-itwould be easy for the guardians, or an inspector, to affix theamount to be paid to the several district medical officers :-thus,in a metropolitan district, two-pence per head on the total popu-lation of an union (varying as to the amount of pauperism in itsseveral districts) might be apportioned in the following manner :-Three halfpence per head to be paid to the medical officer of themore wealthy district; twopence-halfpenny to be paid to themedical officer of the more pauperized district.The Poor-Law Board considered, that the readiness with

which medical men sought the appointments presented a formid-able difficulty to further burthening the rates in these times.The PRESIDENT having incidentally made allusion to the

Queen’s Speech, in reference to sanitary improvements, he wasasked if, in his opinion, a union of poor-law duties and sanitaryobligations might not be carried out under the General Board ofHealth ? The President begged to be excused expressing anopinion on this point. Much conversation having ensued on the-subject generally, the President stated that he was not ie a posi--tion to pledge himself to any particular course, observing, thatgreat difficulties were in the way of a satisfactory adjustment ofthe question.On the deputation retiring, and thanking the Board for the

patient and lengthened audience granted, Lord Ebrington re--plied, that they felt obliged for the many valuable considerationsand suggestions afforded by the deputation.

Correspondence."Audi alteram partem."

A FEW QUESTIONS—NOT FOR THE FELLOWSHIP.[REPLY OF DR. AYRES.]

To the Editor of THE LANCET.SIR,—In the number of your journal for January 26th, I ob-

serve a series of physiological questions, addressed to the profession, by Mr. Jackson, to which, I think, it will not be diffi-cult to furnish replies, satisfactory, at once, to the writer, andexonerating the teachers of physiology, and the practitionersof medicine, from the reproaches of Mr. Jackson, and thecelebrated theologian and philosopher, Pascal. It must be ob-served, in limine, that the so-called questions are not so muchreal questions as statements, put forward in the form of ques-tions or arguments, after the Socratic method, and as suchthey must receive replies. To commence with Mr. Jackson’ssixth and concluding question, to which all the preceding-questions tend. He asks:-" What will succeeding genera-tions of physiologists think of their predecessors, who, up tothe middle of the nineteenth century, could even tolerate,much more teach, such opinions as that the digested food, anddrink, pass from the alimentary tube into the lacteals, andthrough the mesenteric glands and thoracic duct into the leftsubclavian vein; and that it is the heart that propels the bloodthrough the liver?" Here we have two assertions disguised asqueries:-first, that the physiologists of the present day teachthat all the digested food; and drink, enter the circulationthrough the lacteal system; and, secondly, that the heart doesnot propel the blood through the portal system of vessels.Now, as regards the first of these assertions, that physiolo-

gists of the present day teach that all the digested food anddrink are absorbed by the lacteals, and conveyed to the bloodthrough the medium of the thoracic duct, I may remark,either that a long period has elapsed since Mr. Jackson at-tended lectures on physiology, or, that he has not consultedthe recent handbooks and treatises on physiology, none ofwhich, so far as I know, justify his astounding question. Beit known, then, to Mr. Jackson, who so unmercifully falls foulof the physiologists, that Majendie long ago proved, byexperi-ments, that veins absorb; that watery and alcoholic fluids re-ceived into the stomach are taken up by the veins, and not bythe absorbents; and, as the whole of the venous trunks of thestomach and intestines empty themselves into the portal vein,.it is equally conclusive that such fluids pass through the por-tal, and not only the portal, but the pulmonic circulation, be-fore they enter the general circulation? Other experiments,on the transmission of colouring matters, that of rhubarb, for-example, were made in the earlier part of the present cen--tury-if my memory does not deceive me, by Sir EverardHome-have demonstrated, that while the colouring matter