the excitation take place in one of two nerve cells lying side by side, and between which there was not any original specific difference, there will be afterwards a difference between them. This physiological process, whatever be its nature, is the physical basis of memory, and it is the foundation of the development of all our mental functions.” 1

I am not aware that now, twenty years after these words were written, any more can be said upon the subject. For us as physicians, and in connection with our present theme, it is enough that no manifestation of mind can occur without cellular excitation, and that such cells are portions of an organism which is one and indivisible, however various the functions of its several organs, or of portions of the latter, which I shall refer to again as organules.

These cellular activities and persistent impressions are proper to all animal life, and are capable of influencing the organism manifesting them for good or for evil. In the microcosm of man, however, we have to deal with a development of ideation as peculiar to him as the maintenance of the erect position. When Mephistopheles wrote in the album of the young student, "Eritis sicut Deus, scientes bonum et malum," that profound judge of human nature added, as the awestruck boy withdrew, and with something as nearly approaching a sigh as His Highness was capable of, "A weary man thy likeness to the gods will make of thee." This likeness to the gods, however indistinct at times that image may become, the physician has to bear in mind in every department of the healing art, outside the sphere of veterinary medicine. For, while the first impulse of every living creature is to live, the desire of an ideational creature is to live in accordance with that which makes life precious to it, and which is not always of the most Godlike nature. These are self-evident conditions, which do not admit of argument. The suicide terminates his existence, when his brain is not disorganised, and sometimes probably when it is, not because he has ceased to desire life, but because he cannot live the life he desires. Even when he has no thought of laying violent hands upon himself, circumstances, whether they favour the attainment of his ideal or no, act upon his cogitative cells so as to generate stimuli of an invigorating or depressing character, as Dr. William Falconer of Bath, writing from his knowledge of the long experience of man, rather than from physiological investigation, pointed out more than a century 1 "The Physiology of Mind," 1876, p. 27.

ago in the first Fothergillian prize essay.1 Such stimuli by efferent channels act in promoting the health and life or disease and death of the viscera, and of the body of which they are a part. Physical disorders, on the other hand, which impair the nutrition of the centres of vital force, directly or indirectly produce similar results, in various ways, with varying rapidity, and in varying measure.

How often, for example, do we encounter cases in practice, in which the weariness of life causes the patient to desire death, when the actual cause of disturbed health or happiness appears to us quite inadequate to account for so much distress. And, again, how frequently do we observe the desire to live strong in those, the cessation of whose discomfort can only coincide with the termination of life. This despondency in some cases, this unquenchable hope of recovery on the brink of dissolution in others, as also the anxious, or calm and herioc, struggle for life in yet others, are noteworthy phenomena, and reveal to us how complex a creature we have to deal with in man. Could we explain more fully the organic relations of the tadium vitae, of the spes vivere vivere, and of that magna quies, that grand composure manifested in face of the still greater quietude of death, we should have made a considerable advance in our knowledge of the relation of the nervous system to visceral disease and disorder. These subjects are, moreover, germane to the topics discussed in a lectureship on mental diseases-that is, on the mental symptomatology of cerebral disorders. As Maudsley has eloquently remarked, in his "Goulstonian Lectures on Body and Mind" (p. 102): "The mental effects of perverted sensation afford a promising field of future research; when better understood, it cannot be doubted that they will explain many phenomena in the pathology of mind, that now quite baffle explanation. It behoves us to clearly realise the broad fact, which has most wide-reaching consequences in mental physiology and pathology, that all parts of the body, the highest and the lowest, have a sympathy with one another, more intelligent than conscious intelligence can get, or perhaps ever will, conceive; that there is not an organic motion, visible or invisible, sensible or insensible, ministrant to the noblest or to the most humble purposes, which does not work its appointed effect in the complex recesses of the mind; that the mind, as the crowning achievement of organisation, and the consummation and outcome of all its energies, really comprehends the bodily life." To a study 1 "Memoirs of John Fothergill," by Lettsom, 1786.

among others of some such points in the pathology of visceral control, and the clinical phenomena observed when such control is impaired, I purpose devoting the remainder of these lectures, appreciating full well the difficulty of the subject, and also my own inability to do it justice.

LECTURE IV.

THE PATHOLOGY OF VISCERAL INNERVATION.

WHEN the founder of this lectureship first conceived the intention of proposing its establishment, which was, I believe, many years before that actually took place, there were, I understand, few if any systematic courses on psychological medicine in this country. I have seen it stated, indeed, that he was himself at one time the only systematic and special lecturer on the subject in Great Britain; and although he had large opportunities for teaching the subject practically, I understand he evoked a very tepid enthusiasm in the matter, and that his classes were never so large as the importance of the subject and the prevalent ignorance of it, at that time, would have rendered desirable. Novel subjects in a curriculum only attract the more prescient students. It is of interest to know that the late veteran head of our profession, Sir William Jenner, was one of the few students who attended the lectures in question.

As, therefore, this lectureship was originally intended to supply in a measure the want of systematic teaching, it was agreed that a considerable number (six) lectures should be delivered annually. Now, however, that psychological medicine is more generally taught, and has acquired an acknowledged importance, which is but an adumbration of its future pre-eminence as a branch of medicine, the raison d'être of this lectureship is not quite the same. It has become, like some cognate foundations elsewhere, a means of bringing before the profession the work of individual lecturers, and what is newest and most important in the work of others in connection with the theme proper to the foundation. But original or new work is an exhaustible quantity, and to spread it over a prescribed number of lectures might be difficult, perhaps tedious, especially to the audience, and certainly unnecessary. The delivery of a smaller number of lectures.

annually, therefore, than was originally contemplated, would seem to be to the advantage of all concerned. I think I am correct in assuming that this is the conclusion at which the College has arrived as regards the character of this lectureship and the duration of the individual courses.

In selecting, therefore, so large a subject as the relation of the nervous system to visceral disease and disorder, I need scarcely state that I had not the presumption, in view of the audience I should have the honour of addressing, to entertain any intention of an exhaustive treatment of material, concerning which many of my hearers would be in a position to be, as some of them possibly have already been, my teachers; but rather to indicate, so far as I could, guiding points in a subject of increasing interest and importance; to endeavour, in short, to discover principles— principia-those light rays of the dawn, the first perception of which, in obscure surroundings, is one of the most exalted pleasures of which the human mind is capable.

In considering some features in the anatomy and physiology of the visceral nervous system, in this place last year, the method pursued was centripetal, we examined the subject from the socalled peripheral nerve-endings in organs to their known or surmised origin in the intermediate or central portions of the nervous system. In referring to some points in the pathology or pathological physiology of the same structures, I propose following the same course.

The pathology of the visceral nerve-ending may be frankly stated to be unknown, although it may legitimately be assumed to participate in the disintegrative changes which may affect visceral nerve trunks, and to which I shall presently refer. We have seen how difficult it is in many cases, and under the most favourable circumstances as to freshness of tissue, to detect the nerve-endings in the viscera, anatomically; and when we remember that some of our best histological methods, such as the chrome-silver methods, are not at present well adapted for pathological work, and that such investigations themselves require an amount of time which is not at the disposal of many general pathologists, it need not surprise us that the pathological changes in the nervous periphery are still in great measure a terra incognita. The recent tendency of physiological thought, moreover, to rob the peripheral nervous system of the very modest amount of subordinate autonomy claimed for it, is calculated to delay active research in this direction. When,