cated touch," is even more highly cultivated in the medical than in the surgical wards.

"Isolating a tumour by palpation," he will discover, was mere child's play compared with "defining the area of dulness" in obscure internal diseases; and the marvellous skill of some physicians in "percussion " and "auscultation" will astonish him far more than lithotomy performed in two minutes.

A man soon tires of plastering and bandaging, but it will be long before his interest flags in making diagnoses in cases of

Bronchitis, pericarditis,

And all the rest that end in "itis;"

Emphysema, empyema,

And all the rest that end in "ema."

The longer he remains in the wards the greater delight he feels in exploring the meaning and value of the "chest sounds" and "heart sounds" which come rustling to his ear through the stethoscope, that useful instrument which some wag has called "a thing to hear what you are thinking about.'

These sounds are described by almost as many terms as Southey uses when he tells us "How the waters come down at Lodore," for they are said to be

loud or low,

clear or faint,

near or distant,

dry or moist,

resonant or dull,

harsh, rough, and brassy, or soft, whiffing, and blowing,

prolonged or jerky, rhythmical or confused, accentuated or muffled,

deep or shallow,

husky and hoarse, or stertorous

and snoring, sonorous or shrill,

piping or purring, chicking or whispering,

booming or murmuring,

cavernous and amphoric, or

tympanitic and tinkling,

creaking or croaking,
splashing or whizzing,

crackling or humming,

These various sounds have an immense interest for a clinical clerk when he has "taken a case" in the "casebook" so well that his physician compliments him on his accurate observations by the bedside, and promises to read the notes when bringing forward the case at the "Medico-Chi. ;" and he finds himself declaring he has "learned more during the months he has 'clerked' for Dr So-and-so than he did all the time he was at the hospital previously."

It is amusing to see how different subjects engross the attention of different physicians, and the clerks of course take after their respective masters. One man is eager only after "diagnosis" and the "physical signs;" another is mad about "chemical and microscopical analysis" of the secretions; a third scarcely looks at any but " nervous diseases;" a fourth is enthusiastic about the "larynx and the laryngoscope;" a fifth gives his whole time to "Bright's* disease;" while a sixth cares for nothing but "treatment." His forte lies in "therapeutics," and he listens quite languidly to the reading of the notes until he hears the magic words "since taking the medicine," which are always judiciously introduced by the sly clinical clerk.

*

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N.B.-" "Bright's disease does not mean "working-man-ism or demagogue fever," but a very interesting disease of the kidney, first described by the late Dr Richard Bright, who, singularly enough, himself died of this malady. He was one of the greatest physicians who ever lived. Dr Bright was lecturer on medicine and physician to Guy's Hospital.

The house-physician and the clinical clerks see the medical cases at the same time that the house-surgeon and the dressers are visiting the surgical patients; and if the dressers are delighted at the prospect of a "brilliant operation," the clinical clerks are just as much attracted to an "interesting P.M."

It is to be regretted that so many obstacles are put in the way of the scientific investigation of disease by the absurd dislike people have to allow post-mortem examinations of their poor dead unconscious friends.

According to the prevailing etiquette of the profession, no "P.M." is made in hospitals without the permission of the friends of the deceased, so many a good case is utterly wasted. Sometimes when permission is given, the family will send a representative to look on, and you may see men with the most scandalous defiance of decency insisting on being present at the examination of their parents, brothers, or sisters, sometimes even passing their remarks on what is done.

One revolting case we remember of a Scotchman who would come to the P.M. on his father, and when the head was opened a student exclaimed, "What a splendid specimen !"

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Specimen of what?" he asked.

"Of apoplexy."

"Ah, I thought so; the old boy got drunk on New Year's day, and he never spoke again."

At the great Imperial Hospital of Vienna it is a law that every patient who dies there shall be examined. The result is Rokitansky's magnificent work on Pathology. Why cannot our hospitals at home make the same regulations? It seems hardly fair that when patients have every attention lavished on them without

any cost to themselves during life, they should deny us the satisfaction of doing what we like after they are dead, and can feel nothing, and will soon be a mass of putrefaction. It has been suggested that every one should have his own medical history during life written by his medical attendants, and then leave word that an "autopsy," or "inspection of himself," should be performed after death. No doubt some curious facts would thus be brought to light.

But we will not enter that ghastly "P.M. theatre to-day; we will wait till the specimen is brought tomorrow into the operating theatre to form the subject of a clinical lecture.

To-morrow comes, and the worthy physician of the case is radiant with pleasure-not because the poor patient has died, gentle reader, but because he has made a "swell diagnosis," which has been completely "verified by the P.M."

I The clinical clerk reads the notes. The poor woman fell and fainted while she was running along very fast (curiously enough, in Fleet Street), and "was brought to the hospital in the following condition." Here the symptoms are described, and the queer sounds dwelt upon which led to the startling diagnosis, that she had "ruptured one or more of the chordæ tendineæ,” or, in plain English, "broken her heart-strings." Young

ladies of course will think they have often heard of people dying of a “broken heart," though dull, matterof-fact persons may pooh-pooh the idea; but such cases do occur sometimes, and every hospital has specimens of them in its museum.

Do not think this physician a hard-hearted man because he was "glad to find the chords were broken;" he

only meant to say he was glad he was right. He is not a bloodthirsty wretch, he is one of the kindest doctors we know, and if you call upon him you may find he has many accomplishments which you would scarcely expect. Would you not be surprised to find a grave lecturer, who seems quite a walking cyclopædia of knowledge at the hospital, unbending at home to be his children's playfellow? Yet such a one we once caught in the act of fiddling to his children on a rainy day because they could not go out, so papa pushed the table aside, sat down on it, and fiddled away till the youngsters were out of breath with dancing!

Then he took a piece of paper, and drew knights, and horses, and arms, and the queen of beauty, until they knew all about a tournament! There's a model papa for you! Yet who would ever suspect him of this who had never seen him draw anything but chalk diagrams on the black-board, or those queer red-andblack water-colour smudges which are the delight of all oculists?

Note on "Broken Hearts," Chapter IX.

Let it not be considered irrelevant or irreverent if we mention here the explanation which has been given of our Lord's death on the cross occurring so long before that of the thieves. In 1847 Dr Stroud published a book 'On the Physical Cause of the Death of Christ,' in which he commented upon that solemn event as described by St John (xix. 32-36): "Then came the soldiers, and brake the legs of the first [thief], and of the other which was crucified with him. But when they came to Jesus, and saw that He was dead already, they brake not His legs but one of the soldiers with a spear pierced His side, and forthwith came there out blood and water. And he that saw it [St John] bare record, and his record is true : and he knoweth that he saith true, that ye might believe. For these things were done, that the scripture should be fulfilled." Our Lord after His resurrection confirmed this testimony, for He said (Luke xxiv. 44), "These are the words which I spake unto you, while I