propose that a case should be considered as lasting three months, after the expiration of which, the application must be renewed, if the case continues, or a fresh illness arises, but the same individual should not be charged more than twice in the year. The medical officer should as now make a weekly return of the sick under his treatment, accompanied with such observations as the cases call for; which return should be examined by the Board, and certified by the Chairman as approved, or otherwise, as the case may be; but all other reports, involving opinions not immediately connected with cases under his care, he should not be expected to make, without receiving a proportionate fee for his trouble. Some provision should be made to ensure promptitude, in the execution of the necessary orders for extra diet, &c., issued by the medical officer;this at present is badly arranged-would it not be well to allow the medical officer to send his orders direct to the parties contracting for the several articles, at least in those cases, where the applicants are receiving pauper relief? The medical districts should be limited to a surface of forty square miles; and no district should furnish on an average more than 600 cases, nor less than 50, annually; neither should a district of forty square miles exceed 300 cases annually-thirty miles 400, and other districts in the same proportion.* I have made no separate provision for attendance, &c., at the workhouse, believing the duties thereof may safely be included in the general arrangement."

The Remuneration of those officers is set forth in the following Propositions, which we find it utterly impossible to abridge.

"First, That the Medical Officer should be remunerated by a 'fixed annual salary,' and a 'sum,'-proportioned to the number of cases attended during the year; but, as the amount of this 'sum' cannot be ascertained before the end of the year, and as the payments are made quarterly, I would advise a portion, from three to five pounds less than the average, to be paid with the quarterly fixed salary,' leaving the balance to be adjusted at the last quarter when the total number of cases will be known.

Second, That the fixed salary' should consist of two sums ;-the first, depending upon the extent of the district, and the progressive value of the whole of the cases occurring therein, and which may be considered as 'milage; the second depending upon the annual number of cases, (the value and number being taken on an average of the three preceding years) † and which may be regarded as a 'per centage' on stock in trade.

The ‘fixed salary' thus established will guarantee the medical officer from loss; (it is much to be feared that Boards of Guardians attach little import to this), the necessity of which will perhaps more readily be conceded, when I affirm that the expenses incurred in conducting a country private practice of 300 cases

"It has been proposed to found the calculation of the value of medical salaries, upon the extent of the district, and the amount of population; this principle, however, can never safely be applied, because the sickly, or healthful character of a district may be quite uninfluenced by the amount of its population; again, the population may be comparatively rich or poor.-An area of forty square miles I know is by many considered too extensive, but with the reservations here laid down I think the objection vanishes."

"In adopting this system where the remuneration has been by a sole annual salary, the first year will necessarily be experimental in regard to the average, as the present returns will scarcely afford a just criterion of the number of bonafide cases; taking this into consideration, I therefore think that ONE FOURTH of the reported cases may be safely and fairly deducted from the three preceding annual returns and the average taken on the remaining three fourths."

+ These expenses do not include the CAPITAL sunk in education, &c. the interest on which cannot be estimated at less than £50. per annum."

annually, averaging 12s. 6d. per case; and still more apparent will the necessity be to guard against anything like risk, when it cannot be disguised, that as surely as the medical officer finds the chances running against him, so certainly will the poor be neglected.

Third, That the milage' should be determined at a rate per square mile, progressively decreasing as the miles increase. That this rate should be such as to give for forty square miles of surface yielding 200 cases annually, the sum of £40.

f.

A progressive rate is absolutely necessary, to afford a fair estimate of the value of the outlay and labour, required to work unequal surfaces; and the same is equally applicable in respect to unequal numbers of cases. I have assumed, that to work forty square miles of surface yielding 200 cases annually, it will be worth £40. Granting this,-which is but reasonable,—I find by arithmetical progression, that the value of the first mile descending, will be £1. 19s. 04d. and that the last will be only of the value of 114d. 44f. I shall perhaps better explain myself by the following example. If forty miles be worth £40. to work, twenty miles will be worth £29. 15s. 14d. by progression, instead of £20, by simple proportion ;-in the same ratio, ten miles will be worth £17. 6s. 4d.-and five miles £9. 5s. 4d. By the same rule the value of any given surface may be found.

Should this proportion be objected to, as not adapted to all circumstances, an uniform rate of £1. 5s. per square mile would best meet the difficulty, and would perhaps give more general satisfaction; at the same time I am rather inclined to adhere strictly to the progressive rate, as being far more equitable. For although certain expenses may be incidental to the performance of a given work, over a given surface, it does not follow that those expenses will preserve an equal or simple proportion to any other space, having the same duties, much less if those duties are not uniform. One horse may be equal to forty miles; but one horse must be had to do twenty;-therefore for working twenty miles, you ought to receive more than one half the value of forty miles, the expenses being nearly the same, notwithstanding, that the labour may be diminished exactly one half. I have said the 'milage' should have reference likewise, to the progressive value of the whole of the cases, (forming the fluctuating salary' which will be described hereafter), and this rather than simply to the number; inasmuch as each individual case will be of unequal value. To illustrate this, I assume 200 cases occurring in a district of forty square miles, for attendance on which, in that space, I allow £40. as 'milage,'—but as 200 cases will give £40. for forty miles, 300 cases would give £60. for the same space by simple proportion ;-this, however, is too much, because the additional 100 cases, would not increase the expenses or labour, by one half; i. e. in the same proportion. I therefore say, let the milage' previously determined for any given surface, bear also a simple proportion to the progressive value of the whole number of cases; 200 being the standard for any district. I fix upon 200 because that number will average nearly 12s. per case* on the whole annual receipt in a district of forty square miles which I consider as only a fair remuneration for the faithful attendance on, and the due supply of medicine (during one year) for, 200 bona-fide cases of sickness, or accident happening in a district of that extent; e. g. as £49. 19s. 4d. the progressive value of 200 cases, is to £67. 9s. 3d. the value of 300 cases; so will £40. the value of the milage for forty miles, with 200 cases, be to £54. Os. 14d. the value of the milage sought for forty miles, with 300 cases ;

:

(£49. 19s. 4d. : £67. 9s. 3d. : : £40. £54. Os. 14d.).

"It will rarely happen that the average per case will exceed 12s. 6d. if this however should appear to be PERMANENT, the district may be altered to meet the difficulty, or the per centage' may be reduced."

instead of £60, which simple proportion would give: the milage then for forty miles, averaging 300 cases annually, will be £54. Os. 14d.; for the same space with 100 it will be £21. 19s. 114d.

Fourth, That the amount of the second portion of fixed salary,'-the 'per centage,'-should be estimated at the rate of £15. per cent. on the average annual number of cases.

This portion of the fixed salary' does not require a progressive rate, as the 'stock' in trade necessary to be kept, will nearly always bear a direct proportion to the number of cases. A valuable feature in the operation of this portion of fixed salary,' will be found in its reducing the difference of value between each case in the lowest degree, consistently with the value (£180.) of the whole 600 cases herein assumed; and yet the difference will be great enough to preserve the principle of the progressive rate,-e. g. the first of 600 cases according to this joint system, will be worth 8s. 113d. f. and the last will be worth 3s. Od. f.;-according to progression only, the first of 600 cases will be worth 11s. 114d.f., the last being of the value of f. This will appear more striking if we calculate upon 200 cases; the value of the first being, by my system, (avoiding fractions) 9s. and the last 7s. averaging 8s. per case ;-by progression only the value of the first of 200 cases will be 12s. and the last 8s. averaging 10s. per case ;-the difference between the first and the last case, in the first instance being 2s. and in the last 4s.

Should the estimates I have formed be considered too high, the per centage here advised may be reduced, but the integrity of the other financial parts must be preserved, at least so far as not to reduce the data on which they are founded.

Fifth, That the remaining sum,'-which may very appropriately be called the fluctuating salary,'-should be ascertained by the same rule as was applied to the milage,'-i. e. the value of each casc progressively decreasing as the number of cases increase; the amount of this 'sum together,' with that of the 'fixed salary,' jointly constituting the aggregate annual remuneration.

I have limited the number of cases which any district ought to supply, to the extent of that district: I likewise limit the number of cases which any one medical officer should have under his charge to 600 annually. These limitations I think most essential to the perfect working of this system, and therefore it is most important that they should be enforced as nearly as possible; this arrangement should not however preclude a firm from holding two districts; neither should it debar the same medical officer from the same privilege, provided the two districts jointly, do not transgress the limitations above set forth. Supposing the 600 cases to occur in a town district, where the milage would be little or nothing;* I think £180. would be a fair compensation for attendance, &c. thereon, for one year, being at the rate of 6s. per case; this being a little more than the average expenses of dispensary practice; and less than the value of each case as estimated by the medical witnesses, in their evidence before the select Committee of the House of Commons.† The 'per centage' to conduct these 600 cases will amount to £90, this forming the fixed salary,'-leaving £90. (the progressive value of the cases), as the fluctuating salary.' Now, if 600 cases produce £90. each case progressively decreasing in value; the first case will be worth 5s. 114d. if. and the last ff.; the aggregate salary' then for 600 cases will stand thus:

square miles."

''Milage' need not be allowed in districts whose area does not exceed two +"See likewise the Petition of the medical practitioners in Gloucester, on the subject of payment per case. In reference to this valuable petition, I here take the opportunity of expressing my concurrence in its general prayer."'.

Such is the scheme of Mr. Meredith, and we leave it in the hands of the professional public. It may be rather difficult to put in practice, but certainly it seems exceedingly fair to all parties.

ILLUSTRATIONS OF THE COMPARATIVE ANATOMY OF THE NERVOUS SYSTEM. By Joseph Swan. Part V. Price 7s.

THIS admirable dissector and excellent comparative anatomist continues the work before us. It will form a valuable addition to our stock of facts in the anatomy of the nervous system, and must redound to the permanent reputation of its author. We regret the delay that has occurred in this brief notice of the present part. Better late than never.

There are two Plates (the 26th and 27th). The first exhibits the sympathetic nerve in the right side of the calf-the cervical part of the sympathetic of the fox-the abdominal plexus of the dog.

Mr. Swan makes some observations on the connexion between the thinking principle, whatever that may be, and the material organ, which we have much pleasure in noticing. It goes to disprove the popular and most injurious notion, that anatomical pursuits dispose to materialism in its gross and repulsive form. "It has been stated," says, Mr. Swan, "that the basis of the nervous system is the nervous element modified by the different substances of the brain, the spinal marrow, and the ganglions; it must, however, approach to the nature of the immaterial being, as it forms the link which unites this with the material organs and through these with the material world, every part being duly sustained by the vital influence of the blood. But some portions of the nervous system minister to its power in a much greater degree than others, and particularly the convolutions of the brain, these are proportionate with the intellectual faculties, to which they give them a wider or more limited range, according to their development; they do not, however, form any part of the immaterial being, but are the mere instruments for its use and power, and necessary for its improvement and enlargement, for it remains mute and passive, exalted or debased, according to its neglect or cultivation, or improper use through these means. Besides the special influence admitted from the senses, it can, for particular purposes, through the material organs, call into action various parts of the body, and render these subservient to its power, in a manner unattainable by similar ones in animals, which are incapable of being raised above their natural state, except in a very slight degree."

"The brain," he goes on to say, his language perhaps being open to some objections, "is the medium through which the mechanical forms, admitted by the eye, are conducted, as well as the different forms of the air in sounds by the ear, and the influence of the organs of the other senses; but the power of comparing and arranging these impressions in thinking, is independent of the material organs, and is an operation of the mind. But although the mind may seem to have been produced, it has only been instructed, and had its powers made apparent through the healthy brain, receiving impressions from without,

and imparting others by the nerves to various organs of the body, and producing speech, writing and other accomplishments."

"The mind may seem to be annihilated by apoplexy, or to be perverted in madness, but these are only defects of manifestation, arising from a derangement of the parts of the brain forming the medium of communication between the immaterial being and the material world; it is possible, however, that the mind may be primarily disordered, and involve secondarily the material organs.

After the extinction of the nervous element at death, the immaterial being, or that termed animus by Cicero, still lives, but ceases to will or receive impressions through the material organs. Mihi quidem nunquam persuaderi potuit, animos, dum in corporibus essent mortalibus, vivere; cùm exissent ex iis emori : nec verò tum animum esse insipientem, cùm ex insipienti corpore evasisset; sed cùm omni admixtione corporis liberatus, purus et integer esse cœpisset, tum esse sapientem.'

The second Plate shews us the connexion between the uterine and mammary nerves of the ass-the caudal nerves of the calf-the spinal marrow of the hedgehog the spinal marrow of the baboon-the spinal marrow of the dog.

The dissections, from which the plates have been delineated, were evidently laborious and, no doubt, correct-the plates themselves are spiritedly got up. The letter-press contains much valuable information on the comparative anatomy of the brain, information of which we shall probably avail ourselves anon. We wish Mr. Swan health to pursue, and public patronage to crown his labours.

NOTICE SUR LE MONESIA.

Mr. Bernard-Derosne, a pharmacien of Paris, has drawn the attention of the profession to this substance, which is obtained from the bark of a tree growing in South America, and to which very wonderful virtues are ascribed. It was introduced into Europe by a French merchant under the name of monesia. It has been employed by several Parisian physicians for two years past, with, it is said, considerable success-especially in scrofulous affections. This bark is of a brown red colour, breaking short and smooth. The extract, as received from America, is nearly black-entirely soluble in water; its taste is at first sweetish, and afterwards astringent, leaving an acrimony long on the tongue. Internally it has been exhibited in bronchitis-hæmoptysis-phthisis-weakness of stomach-diarrhoea-enteritis (?)-leucorrhoea-menorrhagia-blennorrhagiascrofula scurvy. Externally in ulcers of various kinds-purulent ophthalmia -hæmorrhoids-ulcers-leucorrhoea.

In chronic bronchitis, the monesia has been administered sometimes alone, sometimes with opium. It appeared to promote expectoration and render the breathing freer. In several cases of hæmoptysis, where the hæmorrhage continued, and resisted other remedies, the monesia succeeded. Although it could not be expected to cure pulmonary consumption, it is said to have been useful in such cases, as a stomachic and expectorant. Debility of stomach is one of the maladies for which the monesia has been prescribed, and it is averred, with singular advantage, in doses of 16 grains daily of the extract. Chronic enteritis, as evinced by diarrhoea and pains in the line of the digestive tube, is enumerated among the diseases which have been benefitted by the present remedy. Passing over leucorrhoea, menorrhagia, blennorrhagia and scrofula, we are informed that, in ill-conditioned ulcers, the internal and external administration of monesia has been found very beneficial.

The best internal form of giving it is in pills made of the extract, the dose from twelve to thirty grains daily. For ulcers, the pomade is used-or the powdered extract sprinkled over the sores.