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that your prognostications were about to be realized, and thoughProbably the excitement and confusion which seems to exist inthe minds of the surgeons of this country, may prevent our

obtaining a higher position than we held before the introductionof Sir James Graham’s Bill, still we owe you a debt of deep andlasting gratitude for attempting to save us from the degradationwhich might, but for your exertions, have been inflictedupon us.Verily, we have discovered that " Wakley has not solds, nor isthe coin yet found that can buy him over from the cause he hasfor twenty-five years advocated."

I remain, Sir, your very obedient servant,.

A BRISTOL SURGEON.

THE POOR-LAW COMMISSIONERS, ON THE PAY-. MENT OF MEDICAL OFFICERS IN UNIONS.THE rates of the surgical and midwifery fees have continued inseveral unions to create objection; but these payments are nowgenerally acquiesced in, since the boards of guardians havelearnt, by experience, that the increase of expenditure, and thevarious evils which they anticipated from the introduction of thefees in question, have not, in fact, been produced. The follow-ing is the amount of the expenditure for medical relief in eachyear since 1838:-

In regulating the remuneration for medical relief, our objecthas been to secure to the medical officer such a payment as wouldenable him to discharge his duty to his pauper patients, and toiurnish them with proper medicines. In fixing this amount, how-ever, it is necessary that we should keep in view the value (theprice) at which the services of a medical man are attainable for thispurpose, under the existing circumstances of the profession. Ifthe commissioners were to attempt, by their regulations, to fixthe salaries of medical officers at a rate higher than that at whichcompetent medical men are willing to accept the office and performts duties, the result would be, that the medical offices of unions

1would become the subjects of sale, more or less concealed, and thepauper patients would derive no benefit from the excessive pay-ment. A case, which affords an illustration of this principle, hasrecently occurred in the South-Dublin Union. It appears that

upon the resignation of one of the medical officers for the work-house, an arrangement was made by the retiring officer withanother medical gentleman, that the latter, if elected his successor,would pay him a sum of 3001.; the annual salary of the officebeing 100/. We think that the transaction to which we now referaffords a sufficient proof that the mere act of fixing a higher salaryby the commissioners or the guardians cannot, as a matter of

course, bring about the result that the increase of salary to amedical officer will secure more attention to the duties of the officewhich he holds. The increase, instead of acting as a constantstimulus to the exertions of the medical man from day to day,with reference to the persons to be placed under his care, mayhave passed out qf his pocket by anticipation, and have gone simplyto enrich his predecessor; nay, he may, by this very payment,be left encumbered with debts and difficulties which wouldrsther impede than facilitate the discharge of his duties, especiallyif he had to provide medicines at his own cost.The questions which at present create the chief embarrassment,

in connexion with medical relief, and which admit of the leastsatisfactory solution, are those which arise from the inconvenient,intricate, and obscure state of the law respecting medical qualifi-cations.-From the Eleventh Annual Report of the Commissioners,published in June, 1845.

PROCEEDINGS UNDER THE VACCINATION ACT.IT was with regret that we perceived, last year, from the Regis-trar-General’s Quarterly Tables of Mortality, that the deathsfrom small-pox continued on the increase, notwithstanding theextent to which vaccination was carried on throughout Englandand Wales.

Towards the end of the year we caused returns to be trans-mitted to us from the several unions and parishes, stating thenumbers vaccinated during the year ending 29th September, 1844.We have since received returns from 542 unions and parishes.The births in the 542 unions from which returns were re-

ceived (after estimating the births for those unions the returnsfor which were imperfect) amounted to 452,000. Of the childrenborn in 1842, about nine per cent. died under the age of threemonths. Assuming, therefore, that the ratio of deaths under

that age in the 542 unions, during the year ended 29th Sept.1844, was the same; 39,300 children died in that year beforeattaining the age at which vaccination is usually performed.This leaves 412,891 children to be vaccinated in the year. It

appears that there were about 290,000 persons vaccinated by thepublic vaccinators, leaving only about 122,400 children to bevaccinated by private medical practitioners, and at public insti-tutions.

’ Whenever we found that the births in any union greatlyexceeded the numbers vaccinated, we requested the guardians tocall the attention of the vaccinators to the subject, with a view tofurther extend vaccination in their districts; and where few ornone had been vaccinated at the appointed stations, we suggestedthat the vaccinators should visit the poorer classes, for the purposeof vaccinating any unvaccinated children. We have also thesatisfaction of learning, from the vaccinators, that although manyof the more ignorant are still averse to their children being vac-cinated, (from the apprehension that other eruptive diseases maythereby be communicated to them,) the prejudice does not nowprevail to so great an extent as in previous years.The public vaccinators return 3,954 cases of small-pox attended

by them during the year, out of which they state that 1,283 werepreviously vaccinated.Of the 290,000 persons vaccinated, the vaccinators returned

278,000 as successful; so that, of the total number vaccinated,only four per cent. proved unsuccessful.The mortality from small-pox in England and Wales, during

the years 1840, 1841, and 1842, was as follows :-1840, 10,434 ;1841, 6,368 ; 1842, 2,715.The fees paid to the public vaccinators in England and Wales,

during the year ended 25th March, 1844, amounted to 16,6941.,being an increase of 675L upon the amount paid in the previousyear.The Vaccination Act in Ireland, although not duly carried

into effect by the guardians of many unions, has neverthelessobtained a wide and beneficial operation, which we trust is incourse of gradual extension.The amount expended for vaccination, in the year ended

29th September, 1844, in all the unions in Ireland, exceeded4,000l. The usual rate of payment, was Is. on each successfulcase, for the first 100 cases in the year; and 6d. on each success-ful case, for the remainder.-The same Report.

FREEMASONS’ TAVERN.

TUESDAY, JULY 15.—GEO. BOTTOMLEY, Esq. in the Chair.MONDAY, the 14th, having been named by Sir James Graham asthe day on which he would announce his new proposals respect-ing the Medical Bill, the committee was summoned for thisevening, when a full meeting took place.The expected announcement by the right hon. the home

secretary having, however, been again postponed, that part of thebusiness of the evening which related to this subject wasnecessarily deferred. The following resolutions were, however,unanimously adopted;-

1st. That the chairman and honorary secretaries do prepareand present a memorial to Sir James Graham, for and on behalfof the twelve hundred gentlemen, fellows and members of theCollege, who have signed the requisition to Mr. Guthrie, prayinghim not to advise her Majesty to grant a supplemental charterto the Council of the College of Surgeons of England, or anyother charter to the medical profefsion, until the members of thatprofession shall have been made acquainted with the intendedprovisions of such charter, and until after they shall have hadsufficient time allowed to them to express their opinions on thesubject.

2nd. That a sub-committee, consisting of seven of the mem-bers of this committee, with power to add to their number, beappointed, to consider what questions it will be necessary to sub-mit to the aggregate meeting of the fellows and members of theCollege of Surgeons, and to report to this committee on the sub-ject at an early day.

All the members of the committee in attendance consideredthat the requisitionists had obtained the first of a series of vic-tories, which would be productive of immense benefit to the publicand the profession. The country surgeons were most warmlylauded for their opposition to the contemptible Gallipot-Lodgeproject.

Two hundred and seventeen physicians and surgeons arrivein this country (America,) annually from Europe, accordingto statistical returns from the department of state.