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produced by mental exertion or by moralcauses." Hypochondriasis I never met with in a

collier community, and those who were thusaffected were, almost without exception,puerperal women, or young persons labour-ing under organic disease of the brain." Common hysterical convulsion fits were

not uncommon, but the singular and anoma-lous forms of hysteria, in its modern wide

acceptation, were rarely remarked amongcollier females. I found whisky to be thecommon exciting cause of these convulsionfits, and the subjects were generally strongand florid young women." The various forms of continued fever

were very prevalent among the colliers whocame under my observation. It was a com-mon thing for many families in the samevillage to be ill of fever at the same time, andfor the members of all these families to beaffected. I have seen on many occasions thetwo beds in a collier house filled with personslabouring under typhus fever, each contain-ing four and five at the same time. So com-mon is fever among the collier population,that comparatively few are to be found at thethirtieth year who have not suffered fromthis disease. Death is a common termina-tion of this disease at all periods of life. The

old very frequently fell under this malady ;the middle-aged died less often ; and the

young recovered in the greatest numbers." Many heads of families died of this dis-

ease under my care, and the privation anddestitution consequent on this event was fre-quently of a very aggravated character. Ido not think fever was much more prevalentamong colliers than among other labourers."The exciting causes of this disease are

chiefly referrible to the habits of the colliers,to the condition of their domiciles, and tothat of the atmosphere around their dwell-ings. The habits which are productive offever are dissipation, irregular dieting, andgeneral recklessness. The conditions of thedomiciles favourable to the invasion of feverare those of non-ventilation, darkness, acces-sibility to the wind and rain, general filth,the presence of impurities, and of the generalabsence of necessary furniture and utensils.The condition of the atmosphere around thedwellings which favours the invasion offever, proceeds from the presence of heaps ofcorrupting animal and vegetable materials,known as dunghills, and commonly presentbefore the houses of the collier population."

MEDICAL ETIQUETTE ATCARLISLE.

SUPERIORS AND MENIALS IN DISPENSARIES.

MR. WILLIAM Boyn, a member of theRoyal College of Surgeons in London, hasforwarded to us a letter for publication,

which contains the following statements,presented to the profession by Mr. Boyd " onthe ground of its relation to a subject whichdeeply concerns their general interests,namely, the terms of mutual intercoursewhich ought to regulate the conduct of itsmembers." Mr. Boyd adds, that it is not

without reluctance that he has taken this

step, being but a young member of the pro-fession, but he justly considers that he hasbeen subjected to treatment which it wouldhave been as mean and spiritless in him to

bear, as it was tyrannical and insolent on

the part of those who endeavoured to subjecthim to their authority. Mr. Boyd thus de.scribes this treatment and its history :-

" On the 21st of February last I waselected to the office of apothecary to theCarlisle Dispensary by the medical commit-tee of that institution; on Tuesday, the 1stinstant, I went to Carlisle in pursuance ofthe appointment; excepting with one gentle-man, to whom I had a short time previouslyhad a letter of introduction, I was an utterstranger in the place. My predecessor, Mr.William Reeves, who has just commencedpractising on his own account, had beenunable to attend to his duties at the dispen-sary in consequence of indisposition for aperiod of more than two months, and duringthat time those duties had been dischargedfor him gratuitously by Mr. Dacre, a gentle-man who, although educated to the profes-sion, is not at present in practice. On thesame day that I arrived in Carlisle, Mr.Reeves was appointed an honorary medicalofficer of the charity. With a consideratekindness which I shall ever remember, Mr.Dacre proposed to continue his services inthe institution until I should have becomefully acquainted with the town ; and it was

arranged that he should attend with me tothe patients at that time on the books, whilstI took charge of the new cases. With a listof seventy-seven house patients to be visited,and not fewer than a hundred and thirtyout-patients, the latter of whom I under-stand are usually treated by the honoraryoflicers, I could not but be sensible of Mr.Dacre’s generous proposal, and we wereproceeding upon the plan I have just men-tioned. On the 3rd instant we were calledto visit a patient labouring under peritonitis :his symptoms in the first instance, however,were somewhat obscure ; the seat of disease,as indicated by tenderness on pressure, beingextremely circumscribed, and so close to thegroin as to give rise to some ambiguity.Under these circumstances, and in conse-

quence of being unable to meet with Mr.Reeves at the time, we mentioned the caseto Dr. Barnes, who is physician-extraordi-nary to the institution, and since the retire-ment of the late acting honorary officers, who

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were dissatisfied by the refusal of the gover-nors to reorganise the medical staff, has beenunder the necessity of occasionally attendingin person to a few cases. He saw the case,and directed tho application of leeches tothe abdomen: Mr. Reeves subsequentlyvisited the patient, and recommended the i

free use of calomel and opium. Under this ’,practice, with the addition of general bleed-ing, the case continued to be closely attendedto by Mr. Dacre and myself. On Sunday,the 6th instant, the inflammatory symptomshaving abated, and finding that the patient’sbowels had not been moved for thirty-sixhours, we ordered an enema of warm waterwith a small quantity of castor-oil. A shorttime after our visit, Mr. Reeves called inand countermanded our prescription, stating atthe same time to the mother of the patientthat the direction we had thus given waswrong ! Considering as I did, in acceptingthe appointment, that the utility of the ser-vice I had undertaken to perform must de-pend in a considerable degree on the creditattached to the character and competency ofthe person interested in it, I could not butfeel that, in this case, at least, the patient’sconfidence had been unjustly taken from me ;and Mr. Dacre concurring in this view of thematter, wrote a note to Mr. Reeves the sameafternoon, intimating that in consequence ofhis conduct he should decline all furthercharge of the patient, and giving him to un-derstand that the responsibility of the casewas thenceforward entirely his own. Onthe following day, with the view of prevent-ing any similar interference in future, wecalled upon Dr. Barnes, and acquainted himwith the circumstance above stated. In-

stead, however, of receiving any satisfactionfrom him, we were told that we should nottake any notice of the thing, that we werefar too particular ;’ and on our pointing outthe necessity as well as the propriety of ourobjection to Mr. Reeves’s conduct, he said,, 1’ooh, pooh, its mere professional etiquette,which is all humbug!!’ !’ We afterwards metMr. Reeves at the dispensary, and on Mr.Dacre remonstrating with him on the unkindas well as unprofessional nature of his con-duct, he said something in a hesitating man-ner about our having been mistaken, as thepatient’s mother knew nothing about theenema. On Mr. Dacre pressing him to apo-logise, he flew into a passion, and a shortwhile after left the dispensary, but presentlyreturned in company with Dr. Barnes; thelatter individual immediately accosted Mr.Dacre with an inquiry as to what he had tosay in the matter. Mr. Dacre repeated thatthe behaviour of Mr. Reeves had not onlybeen unkind to him, but that it had beenhighly unprofessional and ungentlemanliketowards us both. Dr. Barnes replied, thathe (Mr. Dacre) could have no business inthe affair, as he was not a legally-qualifiedpractitioner; and coming to me in an adjoin-

. ing room, asked what I had to say upon thesubject; I told him that I perfectly coincidedwith Mr. Dacre in his opinion of Mr,Reeves’s conduct, and that although Mr.Dacre might have been denied the privilegeof a professional man, I begged to remindhim that I, however, was entitled to it. Hetold me that my duty was to act only as Iwas ordered; that Mr. Reeves and he weremy superiors that I was their servant, andthat my business in the dispensary was thatof a mere MENIAL !’ Could I by any possibi.lity have been aware that this or any similarappointment was subject to terms of so muchdegradation, or have anticipated the charac.ter and rude insolence of such self-styledsuperiors, I certainly should not have soughtfor it; and being under no obligation to re,main at the expense of either personal orprofessional honour, I instantly resigned theoffice.

" On Wednesday last, along with Mr,Dacre, I attended a meeting of the quarterlycommittee, and we there stated the circum.stances which have been detailed above.Without receiving any other satisfaction thanthat of hearing a severe reprimand given byone of the committee to Mr. Reeves for hisungrateful behaviour to Mr. Dacre, Iformally relinquished my appointment.After concluding our statement, it was

moved by Dr. Barnes (!) that we should berequested to withdraw; but Mr. Dacre in.sisted upon our right to remain during thewhole of the discussion, and the good senseof the committee had the effect of preventingthis further injustice. Dr. Barnes deniedthat he had used the term menial,’ althoughit was uttered within hearing of a number ofpatients in the waiting-room, but gave no

other explanation of his ungentlemanly coB-duct. He was contradicted by Mr. Dacre,who affirmed that he had distinctly heardhim make use of the offensive word, as wellas the other expressions I have mentioned;although Mr. Reeves, indeed, ventured to

say that he had not heard it. No observa-tions were made upon Dr. Barnes’s conductby the committee, nor was he requested bythem to give any explanation.

« If the details of the foregoing statementappear frivolous, as they very probably maydo in the eyes of those who can appreciatea principle only by the magnitude of the cir-cumstances connected with it, I must be pre.pared to that extent to bear the blame ; at ittevents they are true. It is less than a fort-night since I was an entire stranger to all dieparties concerned ; having had no desire to

mix up any personal considerations with thesubject beyond what are required to explainthe case.

" W. BOYD, M.R.C.S.L." Newcastle-upon-Tyne,

March 16, 1842."

" W. BOYD, M.R.C.S.L