overstrain or prolonged labour, the same loosening of passions long held in abeyance takes place. In this way it sometimes happens that men, who for many years have been the powers and lights and models of the circle in which they move, drop, in their early senility, into animal sensuality, and occasionally themselves defame a name they might have left in the brightness of fame. The effects of degenerations, from the opium. habit, alcoholic inebriety, and other depressing influences in earlier life, lead also to reduction of controlling power of one or both of the cerebral or brain centres. As we gain a physical insight into these modes of motion belonging to our common humanity, a world of light breaks upon our view, teaching wisdom as well as knowledge, and charity as the outcome of both. Our hard-and-fast and narrow dogmas pale in this light. We see before us the healthy, the diseased, the criminal minds at their work. We dissect out the principles leading to motives to detect that motives, good and bad, have their constructive causes, and that a person actuated by good or bad motives must be constituted, temporarily or permanently, for the one or for the other. Some day in the future our criminal codes will have to be reformed altogether, on a system evolutionised from a knowledge of this physical basis of good and evil.

The grand lessons, the immediate lessons, derivable from the study of the duality of the mind, and of the passions as automatic wills distinct from the mind, the grand lessons have reference to the education of communities, first, into structural form and strength; and, secondly, into cerebral activity with uniformity or equality of power. When we see the effects of debility and deformity of the framework of the body in modifying

the equality and power of the central cerebral organs, we learn that with physical impoverishment there can be no intellectual advancement, no control over the animal emotions and passions, no great types of intellectual capacity, no true and sane balance of mental powers. In plain words, we see that to secure sane balance we must build up the mansions of the mind with artistic skill before we attempt to furnish them.

When we have built we must furnish with mental attributes of the best order, for the best purposes; never oppressing one brain at the expense of the other, or the two as one. Dr. Wigan knew the famous statesman William Pitt, whose reckless father, the Earl of Chatham, forced him to unnatural labour, when, as a lad, he was overburdened with the variety of topics, by the saying, "Courage, my son: remember there is only the cyclopædia to learn." He saw the great statesman at Bellamy's, when, in a state of collapse, after the excitement of debate, with a countenance bearing the air of insanity, he would swallow a steak almost without mastication, drink a bottle of port wine almost at a draught, and then, barely wound up to the level of ordinary impulse, repeat the process twice or even three times in the course of the night; a frightful example of over-cultivation of brain before it had attained its full development, and so exhausted by premature and excessive moral stimuli, that when its ambition was sated, it was incapable of even keeping itself in action without the physical stimulants spoken of. Men called the sad exhibition the triumph of mind over matter; Wigan called it the contest of brain and body with victory obtained at the sacrifice of life. To which he added "that it is not to compare little things with large to speak of similar examples in humble

life, for the mind of the humblest mechanic is as important in the scale of creation as that of a king; and I have seen," he continues, "the same wretched results in the case of a little boy perched at a desk as the accountant in the shop of a draper, who had to attend, in rapid succession, to forty or fifty young men bringing their notes of sales to him to be verified and registered. to give correct change to every one while his attention was solicited by half a dozen at a time; and who, rendered responsible for the slightest error on pain of dismissal, went to bed in a state of exhaustion worse to endure than the most excessive bodily fatigue."

In such examples, training of the two mental centres into uniformity of action is simply impossible; and yet in this day, fifty years after the above was written, the same primary errors go on despite our enlightenment, and, as might be foreseen, with increasing insanity; broken balance of mind on every side, a second Babel the ultimate destiny.

I close here, leaving many other lessons that could easily be drawn, for inference rather than description. Suffice it to sum up with these facts. (1) That all mankind is dual in mind by natural construction, so that a congregation of human beings, large or small, a family circle, a private meeting, a parliament, a nation, must always be reckoned as twice its individual number before its mental constitution and strength can be properly appraised. (2) That the efforts of all should be directed to the proper construction of the casket of the mind and the physical powers working it. (3) That mental work should be for progress in ways of unity of purpose, towards greatness of life and character.

ON

INTRA-THORACIC AUSCULTATION :

A NEW DEPARTURE IN PHYSICAL
DIAGNOSIS.*

M

R. PRESIDENT AND GENTLEMEN,-I had promised to bring before the members of the Medical Society of London this session a paper on "Some New Researches in Synthetic Pathology," but as I was not prepared for so early a call for the paper as that which has been assigned to me, I have been unable to complete it in the form in which I would wish to present it. It happens, however, that I have at hand a short communication which I have much pleasure in submitting to you, and which, because it is extremely simple and practical, will, I trust, be accepted as a substitute for the longer and more ambitious essay.

I call the present essay a study of Intra-thoracic Auscultation, a New Departure in Physical Diagnosis, and I cannot introduce it to your notice better than by relating how it came into my mind and practice. A few months ago a patient consulted me who was suffering from serious and obscure symptoms referable, by the process of exclusion in diagnosis, to the upper portion of the alimentary canal. He had lost flesh

1892.

Paper read before the Medical Society of London on October 31st,

to an extreme degree, was very feeble, had often a difficulty in swallowing food, at times retained food of a fluid or semi-fluid kind in the stomach for long periods, and then after suffering severe pain vomited it with difficulty, returning it in a partially digested state. I looked upon the symptoms with suspicion as possibly indicating malignant disease of the lower part of the oesophagus; but as I found he had been following an imprudent dietary, I was content at the moment to regulate diet carefully and to prescribe a mixture of dilute hydrochloric acid and pepsine. He left me, to return in two months reporting himself in every respect better. He had gained in flesh, he retained food, was free from acute pain, had improved in strength, and had lost a sense of weariness of mind as well as body, which had been most oppressive. He had determined to take a holiday, and I agreed with him that the change he suggested would be advantageous. I did not see this patient again for three months, when he consulted me once more in consequence of a sudden return of his worst symptoms, to which were added others pointing more decisively to œsophageal mischief low down in the tube. With difficulty he had partaken of a rather too copious meal one day previously, and soon afterwards had been seized with acute pain, which lasted until the undigested mass had been vomited, with free secretion of the gum-like mucus characteristic of stricture. He was again greatly emaciated, presented a condition of circulation so feeble that I could scarcely detect the radial pulse, and the heart was so weak that it was difficult to distinguish clearly the two sounds.

I tried in this case what I have called the watergurgle test for the diagnosis of stricture, as described