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of our troops-we pointed out to the attention of the autho-rities the want of that organization and responsibility in theconstitution of the Medical Departments which is now so

universally felt and deplored.

THERE can be no question that a sufficient supply of com-

petent and experienced surgeons adds greatly to the importanceand strength of our militia regiments. When confined to dutywithin their own counties, even under the unjust regulations at present in force, the militia might reckon upon the attend-ance of competent medical officers. The pay of the militia

surgeon, though miserably inadequate, afforded him at leastsome remuneration for the duties which he had to per-form. The honour, too, of serving her Majesty is regarded bymembers of our profession to its full extent. Hence, the militia

regiments raised in the various counties of the empire have hadattached to them, in the capacity of surgeon, many of the mostrespectable names amongst our number. But the framers of

the Militia Pay Bill, ignoring, as it were, all claims to justicewhich the militia surgeon might make under any circumstances,forgot, or intentionally omitted, to make provision for thesegentlemen in the event of their being called into active servicein distant parts of the empire or abroad. It seems strange,that whilst the possibility that the militia regiments might beengaged in foreign service was contemplated, no provision wasmade for the half-pay of those who, as surgeons, accompaniedthem. The natural result of such an ill-judged piece oflegis-lation must, as Lord DERBY lately observed in the House ofLords, be the withdrawal from office of competent and educated

gentlemen, or the infliction upon them of an act of the grossestinjustice. It can scarcely be supposed, however, forbearingthe members of the medical profession have hitherto been, thatthe framers of the Bill in question could have anticipated thatthe present militia surgeons would have consented to leave ehome and practice on such terms. If they have laboured, how-ever, under this hallucination, it must by this time have been

dispelled. A strong feeling of dissatisfaction and indignationpervades the ranks of the militia surgeons, and we trust thatsome alteration in the law, consistent with common sense andcommon justice, will be made. We fervently hope that anunited effort may be made to obtain from the Government an

equitable consideration for services performed. Memorials

emanating from every county and city in the United Kingdom,expressive of the grievances of militia surgeons, could not failto attract attention; and attention once being roused to what is

palpably, to the commonest understanding, a gross injustice,must result in the obtainment of a complete and satisfactoryremedy.

Medical Jurisprudence.INQUESTS AND MEDICAL TRIALS.

UNDER these titles we intend to open a department in THELANCET for the insertion of many subjects of vast interest andimportance to the medical profession. The subject of medicaljurisprudence, notwithstanding all that has been yet done,is ill-understood, and accordingly we find that much ill-natured criticism is often directed against medical wit-nesses when they appear eiLher at inquests, or in the supe-rior eourts of law. Although many of the critics condemn

most unsparingly the regulations of the coroner’s court, it iscurious to observe how barren are their censures of every.thing that is calculated to promote substantial improvements.The most fertile themes of condemnation are the proceedingswhich take place at inquests held before coroners. That allsuch reproaches are misdirected it would be wrong to assert;but that many of them have been written in the absence of aspirit of candour must, we apprehend, be but too truly acknow-ledged. Our efforts, therefore, in this department will bedirected towards effecting substantial and lasting improve-ments. In all instances, whether at inquests or in trials atlaw, the interests of the profession and the due administrationof justice are prominently concerned. It is anxiously hopedby us that increased information, and an industrious collectionand record of facts, will lead to the establishment of somethingapproaching to a code; whereas, at this time, from the utterabsence of system, and a complete want of anything likeuniformity of action or proceeding, there is little else thananarchy and confusion. Hence, on subjects of perfect identity,we find practitioners of eminence giving evidence as to a singlefact of a precisely opposite character, to the utter confusion ofjuries, the dismay of judges, and to the great discredit of theprofession. With the promised valuable assistance of Pro--fessor ALFRED TAYLOR, of Guy’s Hospital, and Dr. FARR, ofthe Registration Office, we hope to obtain for this departmentof THE LANCET the approval of our profession and the sanctionand confidence of our courts of law.

Correspondence.

THE PROVINCIAL MEDICAL AND SUR-GICAL ASSOCIATION AND THE "ASSO-CIATION JOURNAL."

"Audi alteram pattem."

WE have been requested by the author to publish the fol.lowing letter :-

To the -41enibers of the Provincial Medical SurgicalAssociation.

GENTLEMEN,-This may not be an improper period to ad,dress you upon the position of our Association. At the close ofthe year it may be well for us to take a retrospect of what wehave done to carry out the original object of our founderduring the past twelve months.Undoubtedly, the main object of that eminent and bene-

volent physician, Sir Charles Hastings, was to establish amongstthe members of our profession, particularly in the country,a feeling of kindly consideration and brotherhood towards eachother. Fully impressed, as he must have been, from the atten-tive consideration of the difficulties which we had to encounter,he was desirous of establishing such a bond of union amongstus as would enable us to successfully resist the assaults of ourenemies, from whatever quarter they might emanate. If thismost praiseworthy intention was not always fulfilled, it was notdue to our illustrious founder, but rather to the circumstancesin which we, as an intelligent and scientific body, had beenplaced. Whatever the shortcomings of the Provincial Medicaland Surgical Association may have been, up to a late period atleast, they have not been owing to a want of unanimity andkindly spirit upon the part of the members at large ; for until, inan evil hour, when the Journal was committed to the charge ofDr. Cormack and an unscrupulous London clique, the council andmembers of the Association acted in unison and concord witheach other. It is not necessary now to refer to the successfulefforts of the Association in the cause of the great body of me-dical practitioners who constitute the country surgeons of thiskingdom. Those labours and those successes are recorded inthe memories of every one of us. When it was determined bya party, only anxious for power that it might serve its ownselfish ends, to remove the centre of action from the provincesto London, no efforts were spared to effect that object.A meeting was held at Oxford, packed by the new combina-

tion, to ruin the Association. Unfortunately, the majority ofthose who had weight and influence in our councils held alooffrom the contest ; and, byarMMmost dishonest and unjustifiable,a majority of one carried the motion that the Joiti-7ial shouldbe removed to London, and conducted under the auspices of ametropolitan clique. I say a )-u-3e, because it is well knownthat a fallacious amendment was proposed with a view of

18

associating in the movement many who were opposed to itsreal objects. The trick succeeded. A Journal committee wasappointed, and under its jurisdiction the name of the Journalwas altered, and the Provincial Medical and Surgical Associa-tion, as such, ceased to exist. I will not pain you with recallingto your recollection the first fruits of this disastrous proceeding.Influenced by that unscrupulous body, who have on. alloccasions strenuously endeavoured to keep down the medicalpractitioners of the country districts the Journal became theexponent of their exclusive views. A case occurred. A surgeonto an hospital had been expelled from his office for what was re-garded as a flagrant attack upon his colleagues. The editor ofthe Journal sided with him; and, totally forgetful that it oughtto represent the opinions of nearly 2000 of our members, sold totwo persons interested in the contest an entire edition, whichwas circulated gratuitously to every member of the professionthroughout the kingdom. Such a proceeding could scarcelyhave been justified, even had the actors in this affair been in-fluenced by motives which were calculated to be beneficial tothe profession at large.But mark! a short time afterwards two gentlemen were

placed in difficulty in consequence of an unsuccessful operationat one of our Hospitals, in which one of them was the chief

actor, and the other at best but an assistant. It was a case

deeply interesting to all of us, because at any moment anyone of us might have been placed in the same position. Whatdid the Journal do? Did it stand between the aggrievedparties and the public ? Did it endeavour to extenuate whatwas at most a mistake-a mistake which might have occurredto the first and foremost in the practice of surgery ? No ! Itsought by every means in its power to injure these gentlemen,and, under the guise of a canting philanthropy, talked of therights of the poor, and the ignorance of incompetent surgeons.It is unnecessary for me to point out to you the motives whichactuated the editor on these occasions. They are too trans-parent, and can only excite our disgust and indignation-let thatpass. Not satisfied with bringing the Journal to London, theclique, backed by that eccentric, fluent, and mistaken calculator,Dr. Cowan, of Reading, determined still further to separate ourinterests from theirs at the Manchester meeting. To effect this,the most unscrupulous means were resorted to by whatDr. Conolly justly denominated a "packed meeting." Dr.Cormack, in addition to his editorial duties, was appointedsecretary to the Association ! This, in fact, entirely separatedour interests from those of the London clique. The Worcestercouncil, it is true, remained the same in name, but as an ex-ecutive body ceased to exercise any influence upon our career.T’ne nature of the opposition with which you have to con-tend, is strikingly illustrated by the mode in which the"packed" meeting at Manchester performed the most un-justifiable act alluded to. They set at defiance the laws of theAssociation which for twenty years had regulated our pro-ceedings. The very appointment of a London secretary was aninfringment of the fundamental laws of our body. But theinsult to us was perpetrated. Dr. Cormack became secretary bythe votes of the " packed " meeting ; and now appears, withhis friend Dr. Cowan, to set us at defiance. Need I allude evenfor a moment to the treatment which our able and amiableassociate, Dr. Lyon, has been exposed with reference to thismatter ? Surely a greater outrage on justice and good mannerswas never perpetrated-an outrage without an excuse, or evena palliation. Well might Mr. Vicary declare that he "leftManchester strongly disgusted with all the proceedings." Butobserve the miserable subterfuge to which the editor resorts tojustify his conduct with respect to the suppression of our com-munications, when not favourable to his mangesient of theJournal, or on other points in which we differ from him onAssociation matters. His interest does not allow him to fillthe Journal with controversial or party matters. Let meremind you that this is the conscientious editor who for weeks

occupied his .ToM’M&mdash;for it is not ours-with subjects of themost irritating and disgraceful character; who sold an editionof the Journal to gratify personal feelings; and saturated us,ad nauseum, with reports of the famous O’Connor row, by whichthe profession was insulted and scandalized by the low person-alities of the discussions. This is the same editor who for weeksmade the Journal an .E’faM:y<c< .AfeaxMte. To gratify whom ?&mdash;a miserable section of the Association. Allow me also toremind you, that the week after his most impudent notice tosuppress whatever communications he pleased, and his offen-sive offer to print the letters of Dr. Lyon as an advertisement,at his "own expense," a long letter from Mr. Henry Ancellappears in the Journal in defence of its management, and insupport of the doctrine that a Journal is the main object of the

Association. This letter, recollect, is in favour of Dr. Cor-mack, and of course is inserted in the body of the work to theextent of several columns ! Turn over a few pages : the offen.sive advertisement appears ! But who is Mr. Ancell ? Oneof the most active of the London clique, and the late secretaryof an Institute which had for its object the establishment of anew college of apothecaries, and the sinking of the honourabletitle of " surgeon" to that of "general practitioner "-ascheme which would have probably been carried, in spite ofthe remonstrances of the great body of surgeons throughoutthe country, but for the unceasing efforts of an independentpress. And what has been the result of all this cliquism-law breaking, personal abuse, cant, and the suppression of com-munications which told the truth, and were disagreeable to Dr.Cormack ? We have an Association in a state of disorganiza-tion, with a council powerless to effect any beneficial change.We have a Journal conducted in a manner and with a spiritthat has disgraced the profession; and which, from its scurrilityand personal attacks, and low ideas of editorial morality, hasmade the " honour and dignity" of the Association a byewordand a sneer ! We are encumbered with a formidable debt, forwhich each of us is individually responsible. We profess tonumber upwards of 2200 members, when in reality they arenot more than 1800, and these are daily decreasing.

Such, gentlemen, are some of the results of the past year,arising from the low, personal, and party spirit, which hascharacterized the Journal. I make no apologies for address-ing you through the pages of THE LANCET-the voice of re-monstrance will not reach you through that which is styledyour own Journal. I beg to remain, gentlemen,

Your faithful servant,ONE OF THE ORIGINAL MEMBERS

OF THE PROVINCIAL MEDICALDec. 30,1854. AND SURGICAL ASSOCIATION.

ON THE MICROSCOPIC APPEARANCES IN THESPUTA; AND ON FATTY DEGENERATIONOF THE BLOODVESSELS IN PULMONARYTUBERCLE.

l’o the Editor of THE LANCET.

SIR,-As your " Reviewer" requests communications uponthe microscopic appearances of the expectoration in cases ofphthisis, I forward the following extract from an essay,the publication of which has been for some time awaiting thefinal arrangements of " the powers that be," in the Pro-vincial Medical and Surgical Association, as to the mode andmedium :-

" Sputa. -If such be the real course pursued by the localdisease, we shall naturally expect to find some evidence of fattyepithelial cells being cast off from the air-vesicles in the

expectoration at the commencement of phthisis. This corrobo-ration is not wanting. I have made careful examinations ofthe sputa in cases in which the deposition of tubercle appearedthreatening, but in which no auscultatory proof was detectible ;in cases of phthisis in its earliest confirmed stage, and in otherswhere the disease was of old duration and in its third stage.The following is the sum of these observations on the sputa, inimpending, incipient, and established phthisis :-" Common to all. -Flat pavement epithelium, with sharp,

clear, nucleolated nucleus, entire or partially dissolved, frommouth or pharynx. Bronchial columnar epithelium. Filmycells, containing two or three dim granulous nuclei from tonsils.Pigment cells."Impending Tuberculization of Lungs. - Expectoration

grey, glairy, adhesive; brought up chiefly when dressing in themorning, and scarcely noticed or thought of by the patient. Ifinnocent, (which, of course, it generally is,) it consists merelyof round, nebulous, mucous cells, in transparent adhesive mucus.If threatening, it presents in addition single cells, or smallflakes of flat epithelium from the air-vesicles, fattily dege-nerating, and bronchial columnar epithelium also presentingvarious degrees of fatty degeneration.

" Incipient lube2-culization. -The same as the above; andin addition, red blood-corpuscles, more or less shrivelled andfaded, enveloped in a filmy cell; a few large, many-nucleatedcells; granules; and frequently small casts of air-vesicles andthe ultimate bronchi, in which are plainly visible epithelialcells in various sizes and various stages of fatty degeneration.So constantly have I met with enveloped blood-corpuscles insputum which betrayed no appearance of blood to the nakedeye, that I suspect this microscopic haemoptysis is seldom,