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acoustic principles. There is in some minds (to use an expression of Dr. Markham's),* “a barrenness of faith” leading them to distrust the details which conduce to a general truth, and it is doubtless possible to be unnecessarily minute in distinctions of sound; but the misuse of auscultation arises less frequently from undue refinement, than from a want of correct appreciation of the distinctions which are most significant in their indications, and most important in relation to practice. Disproportion is a principal cause of erroneous opinion, no less than of monstrous forms ; but the errors of observers must not be charged on the method of investigation. It is better to begin with doubts and end with certainty, than to begin with confidence and end with distrust ; but the intelligence of the present race of practitioners offers a guarantee for the judicious cultivation of this branch of science; and I cannot question that, whilst auscultation is studied with the caution and ingenuousness characteristic of true philosophy, it will never lose ground in the estimation of the Profession.

* Introduction to Translation of Skoda.

CLINICAL LECTURES

ON

DISEASES OF THE CHEST.

LECTURE I.

Importance of general symptoms—Physical signs-Hooke, in

the seventeenth century, the proposer of Auscultation Laennec---Importance of visible signs-Hydatids expectorated -Cracked-pipkin sound-Modifications of movement of chest by Phthisis-Pleurisy - Emphysema- Causes and treatment of Asthma.

GENTLEMEN,

The hospital in which I have the honour of addressing you was founded for the relief of individuals suffering from a class of diseases, to which more than onesixth of the annual mortality in this country is attributable. The opportunity for systematically studying this class of diseases has hitherto in this country been lamentably deficient, and no argument can be requisite to prove the desirableness of rendering this institution

B

2

IMPORTANCE OF GENERAL SYMPTOMS.

available for the communication of knowledge on the subjects which it is specially adapted to illustrate. With this impression, it has been determined to deliver a course of clinical lectures; and, while conscious of the difficulty of the task which I have undertaken, I am encouraged by the reflection, that my duty is not so much to communicate opinions as to assist you in the observation of facts, and by the conviction that knowledge acquired by your own exertion will take root with more certainty, and prove more productive, than any opinions which I might attempt to transfer to you complete and mature.

Let me remind you, at the outset, that lectures on the diseases of the chest involve far wider considerations than those connected with the science of auscultation alone. The probable duration of the disease, and the chances of its relief, have no exclusive relation to the nature or extent of the local physical conditions. The various circumstances which characterize or modify the general constitutional state of each individual patient must be carefully considered before we can form a reasonable prognosis, or adopt a judicious treatment. Nevertheless, the various modes of physical investigation will, with propriety, engage a large proportion of your attention, for they will well repay your careful study, and will lose their seeming complication when patiently examined.

The systematic application of the ear to the investigation of thoracic diseases is of modern introduction ; but it is not generally known that the suggestion of such a method of inquiry was really made by one of our own countrymen, about two centuries ago.

Robert Hooke, surveyor to the city of London in the middle of the seventeenth century, who is said to have been the inventor of spring watches, and even in his boyhood to have exhibited great ingenuity in the construction of clocks, records his opinion, that some modes of ascertaining the condition of artificial machinery might be extended with advantage to the investigation of the mechanism of animal life. The passage to which I refer is well worth your attention, and is at once so philosophical and definite, that you will probably feel some surprise that such a suggestion should have remained so long unnoticed.

There may be a possibility," says Hooke, “ of discovering the internal motions and actions of bodies by the sound they make. Who knows but that, as in a watch we may hear the beating of the balance, and the running of the wheels, and the striking of the hammers, and the grating of the teeth, and a multitude of other noises,—who knows, I say, but that it may be possible to discover the motions of internal parts of bodies, whether animal, vegetable, or mineral, by the sounds they make; that one may discover the works performed in the several offices and shops of a man's body, and thereby discover what engine is out of order, what works are going on at several times, and lie still at others, and the like. I have this encouragement not to think all these things impossible, though never so much derided by the generality of men, and never so seemingly mad, foolish, and fantastic that, as the thinking them impossible cannot much improve my ledge, so the believing them possible may perhaps be an occasion for taking notice of such things as another would pass by without regard as useless. And somewhat more of encouragement I have also from experience that I have been able to hear very plainly the beating of a man's heart; and it is common to hear the motion of the wind to and fro in the guts and other small vessels; the stopping of the lungs is easily discovered by the wheezing. As to the motions of the parts one among the other, to their becoming sensible they require either that their motions be increased, or that the organ be made more nice and powerful, to sensate and distinguish them as they are; for the doing of both which I think it is not impossible but that in many cases there may be helps found.”

know

It may be interesting to you to hear a few particulars of this ingenious philosopher, a short notice of whom may not be thought inappropriate to the occasion of our meeting

Robert Hooke was born at Freshwater, Isle of Wight, in 1635, and died in 1702. He was intended for the church, but a liability to headache interrupted his studies; and, on attempting to become a painter under the instruction of Sir Peter Lely, the same affliction, aggravated by the smell of paint, again changed his destination. He was for a time pupil to Dr. Busby. In 1655, he assisted Dr. Willis in his chemical illustrations at Oxford, and probably took a part in constructing the first air-pump, introduced by that eminent philosopher, Mr. Boyle. He started some ideas regarding the principle of gravitation, approaching so nearly to those which immortalized Sir Isaac Newton, that this great man, with the ingenuousness of true philosophy, gave Hooke full credit for an approximation to its discovery

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