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analyses them into their simple elements as to enable theanatomist to discover the seat of these elements. For Iconceive that it is the simple operations exclusively whichcan be possessed of seats in the brain. A complex mentaloperation must be the result of one or more seats acting inconcert.

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Before concluding this head, I would remark that itseems as if one obstacle to the proper understanding of thepsychological method has arisen from not drawing attentionto the fact that consciousness has no existence but as acontemplation of its objects. If we would try to think ofthe thought of a rose as something separate from the mentalobject-rose, we find that we cannot do so. All knowing isa relation between one element, the subject, and anotherelement, the object. To try, therefore, to contemplate theone without the other is to attempt an impossibility-namely, to contemplate less than the minimum scibile. Itfollows from this that if the operations of the mind are tobe known, they must be known in thought-objects. Themind, when conscious of its own workings, is so throughthe medium of the thought-objects with which it works.These objects, therefore, and more especially these objectsand their relations as expressed in language, constitute the z,

department of knowledge which it is the province of the ’,psychologist to investigate. The only difference betweenintrospective observation and outward is, that the objectsin the one case are intellectual and emotional only, in theother sensational as well as intellectual. There are no mere

objects as known. What is called an external object is anobject in sensation calling into action thoughts in the intel-lect related to it. The known external object is therefore anobject in sensation, as a whole, discriminated into parts bythe intellect; and when two or more wholes in sensation arethus discriminated, and certain of their parts are found toresemble each other, these form a concept and are givenone name, a name univocally applicable to each and all ofthese resembling parts. The latter, however, it is necessaryto bear in mind, do not form a whole or a general idea bythemselves-that is, the resembling parts of many wholescannot be shaped into a notion without the coexistence ofsome of the dissimilar parts. For instance, we cannot forma notion of a triangle according to the definition withoutcalling in the aid of parts which the definition does not em-brace because not similar in every three-sided figure. Itis impossible to form a notion of a triangle which is neitherequilateral nor the contrary. A general notion, therefore,when realised in the mind, must be so realised in conjunc-tion with some of its accidents-notions less general thanitself. t

II. I proceed, in the next place, to make a few remarks ion the Anthropological method. This method, when setting ’,up for independency, has proved itself quite as liable toerror and romance as the metaphysical dogmatism of theancient and modern world. Let me cite as an instance thatremarkable division of the intellect by the phrenologists intofourteen organs (George Combe). What mind with any geniusfor introspection could possibly make such a division of thefaculties as we have here ? Time distinct from Eventuality;as if events could happen but in time, or time be noted butby the succession of events. Individuality distinct fromSize and Form ; as if individual things, such as trees, rocks,and rivers, could exist without size (occupying space) andform. Objects are first known in perception, and as thusknown we call them percepts. When several of these ob-jects are known to resemble each other in certain of theirqualities, this is called, in relation to the intellect, con-ception (<C con-capere hoc cum Ho")&mdash;in relation to the object,a concept or general notion. Now, since percepts exist, inthe order of knowledge, before concepts, it was incumbentupon the phrenologists to seek organs for the former beforedoing so for the latter. But what have they done ? P Theyhave formed such notions or concepts as individuality,eventuality, size, form, weight, time, &c., and then soughtfor organs for these. But if these notions are already in-volved in the percepts which necessarily precede concepts,what an illogical procedure it must be to map the craniumas the phrenologists have done. According to their owndoctrine, all general notions should be the offspring of theorgan they call Comparison. Notice here especially theabsurd cross division into which they have fallen. Theypostulate a separate organ for such concepts as size, form,weight, time, &c. and then they postulate another organ

for concepts in general. Now, as far as we have been ableto discover, the intellectual mind is seated in so manyper-ceptive centres, each of these being in direct connexion, bymeans of nerve-fibres, with its sense-centre below ; andsuch organs as Comparison and Causality are not wanted,the perceptive centres being adequate for all thought. Itwould occupy too much space to enter with any fulness intothis question here, so I beg to refer the reader to twoarticles in the JoUt’nal of Mental Science; in which the sub-ject is treated at some length.* These remarks, however,may suffice to show how outward observation, without theaid of an introspective, reasoned, and exhaustive analysis,is not to be depended upon when it would attempt to esta-blish a complete science of mind.

It fares as badly with the anthropological method whenit dispenses with the aid of anatomy. Fourteen intellectualorgans in all are assigned in the phrenological map to thefrontal region of the head. Surely we should expect to findindications in the brain of the existence of these organs.But, lo ! there are none. In the anatomical court of appeal,then, phrenology fares as badly as it does in the psycho-logical court. But how fares it with a system of psychologywhich seeks to be reasoned out from all the facts of thecase ? We have arrived at the conclusion that, answeringto the senses of touch, sight, and hearing, there are threeperceptive centres. Now, if this be a correct inference, weshould expect to find three leading convolutions which mayhappen to be the centres in question. Is this expectationverified ? It certainly is a striking coincidence that thereare in the frontal lobe of the brain the three convolutionsknown as the superior, middle, and inferior; and that theevidence, as far as it goes, is in favour of the hypothesiswhich locates the intellectual faculty of hearing in thelast of these. This coincidence, if it does nothing more,at least serves to show that verisimilitude is attained inproportion as the three methods of inquiry are made toconverge to one point.

(To be concluded.)

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

LONDON HOSPITAL.

NOTES FROM THE OUT-PATIENT PRACTICE OF

DR. HUGHLINGS JACKSON.

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborumet dissectionum historias, tum aliorum, tum proprias collectas habere, etinter se compajaje.&mdash;MoBaAejri De Sed. et Caus. 2[form., lib. iv. Procemium.

Subjective Sensations of Smell, with Epileptiform Seizures.-At a visit (Feb. 2nd) to one of the two medical out-patientrooms, Dr. Hughlings Jackson drew our attention to severalcases of disease of the nervous system. One of them wasthat of a patient, sixty years of age, who had epileptiformseizures in association with subjective sensations of smell-a case mentioned in our Mirror, June 16th, 1866; to which re-port we may refer for remarks on this subject. This patientcan smell nothing; and yet has now and then a ‘&deg;stenca in hisnose," usually as his fit passes off. He has had convulsions,in which he has bitten his tongue; but more recently therehave been losses of consciousness, without movement of thelimbs-what he calls attacks of forgetfulness. In these he isunconscious, becomes pale, and usually remains still. In oneattack, however, he went from Poplar to Deptford-eightmiles. The facts are that he lost himself at Poplar, andfound himself again at a public-house at Deptford, where,fourteen years ago, he used to live. He walked, he supposes,

* " The Distinction, Physiologically and Psychologically considered, be-tween Perception, Memory; Sensation, and Intellect," October, 1868, "T4ePerceptive Centres and their ]joeaHsa.tiOD," July, 1860.

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round by London-bridge ; because if he had crossed theriver lower down he must have paid for his passage by boat.Some time since he walked into a canal during a seizure.Dr. Hughlings Jackson’s speculation is that, in such casesas these, there is disease of the brain in the region of theanterior cerebral artery. Bromide of potassium does theman a little good; but it has not had luuuh influence onhis seizures.Such cases of quasi-somnambulism have a medico-legal

interest. (See Bazire’s Translation of Trousseau, vol. i. ;and " iVIasked Epilepsy," by Dr. Thorne Thorne, St. Bar-tholomew’s Hospital Reports, vol. vi.)

Epileptiform Amaurosis. - There are cases in which a

patient suddenly loses his sight. He may go into absolutedarkness for a few moments; but more frequently there isonly great temporary diminution of sight. This symptomDr. Hughlings Jackson used to call "epilepsy of the retina,"but he now prefers the name " epileptiform amaurosis,"since he cannot be sure that the retina is the part at fault,and, indeed, he believes it is not, at all events, the partprimarily diseased. In some cases it is hard to determinewhether the temporary defect be owing to temporary lossof sight, or to failure of accommodation or to confusion ofimages, the result of irregular action of the ocular muscles.When temporary loss of sight is the sole nervous symptom,it is, Dr. Hughlings Jackson believes, impossible to fix theseat-of the lesion causing the symptom, just as it is in caseswhere double optic neuritis is the sole nervous symptom.Neither of these symptoms is, so far as we have yetlearned, 11 localising." Temporary defect of sight may bethe sole nervous symptom in a case, or it may precede aconvulsion, and not unfrequently it is contemporaneouswith a one-sided spasm of the face or hand. Temporaryloss of sight is not the analogue of the subjective sensationsof smell just spoken of, but of temporary loss of smell, acondition of which Dr. Hughlings Jackson has never hearda patient complain. The analogue of the subjective sensa-tions of smell are the temporary sensations of colour, 11 ballsof fire," &c., which sometimes precede convulsion, or arecontemporaneous with the onset of some convulsions, mostfrequently those beginning by spasm of the hand or face.It is to be observed that such subjective sensations of sightoccasionally precede optic neuritis: the development of ’,optic neuritis is to be feared if the patient suffer intensepain in the head. When subjective sensations of sightoccur along with spasm starting in the hand or side of theface, Dr. Hughlings Jackson believes the latter symptomshows the disease to be seated in the cerebral hemisphereopposite the side of the body in which the spasm starts.Here it may be remarked that patients very rarely complainof seizures beginning by subjective sensations of hearing.An analogous fact is that deafness (of both ears) is rarelyseen with convulsive seizures (epileptiform seizures are oc-casionally associated with organic disease of the ear), whilstamaurosis (from double optic neuritis) is not unfrequentlyseen in that association.

Epileptic Aphasia.*-In certain limited convulsions thepatient loses his speech without losing consciousness. Thisis not to be confounded with petit mal. Temporary loss ofspeech most often occurs in those cases of unilateral con-vulsions in which the spasm starts in the right cheek. Tem-porary loss or great defect of speech is observed sometimeswhen the spasm is quite limited to the right side of theface. The patient may consult us because he occasionallysuddenly loses his speech for a few minutes. For instance,he goes to a shop, and on trying to give an order finds thathe cannot talk, or that he talks so badly that he is supposedto be drunk. In a case Dr. Hughlings Jackson had seenfrom the practice of Dr. Hearnden, of Sutton, there was onone occasion loss of speech for several hours, and then aconvulsion, with loss of consciousness ; on two subsequentoccasions there was loss of speech for half an hour. In eachof these seizures there was spasm of the right side of theface, and there is weakness of the right arm and leg-im-perfect hemiplegia. It is important to note the manner oftalking q/’<6f attacks of convulsion beginning in the rightside : but this is no easy matter. The defect is often soslight that it seems to melt into nothing when it is de-scribed. We hope, however, shortly to give details of a

* " There is a peculiar class of cases of epileptic hemiplegia, in which theexciting cause of the epileptic fit at the same time damages or greatly in-fyres voluntary power and speech,"-TODD "Nervous Diseases," Lect, XV.

very remarkable case of epileptic aphasia observed in thishospital by Mr. Stephen Mackenzie; the patient blunderedstrangely in replying to questions. In this instance theexact mode of onset uf the convulsion :was not known; thespasm, however, had been on the right side. It is greatlyto be desired that the patient should be set to write duringthe continuance of the temporary loss or defect of speech.On this point there are few facts. It is worth mentioningthat some patients will say that they can write during theirtemporary condition of speechlessness, when on investi-gation it turns out that they merely assume that they can,and that they have never really tried to write. IN’e must re-member, also, that a patient who is permanently speechlessmay write his name when he can write nothing more, andthat he may be able to copy writing or print. Lastly, it isto be observed that temporary loss of speech for severalhours or days occurs in cases of valvular disease of theheart-presumably from embolism. No doubt also it occursfrom small clots and from thrombosis. Dr. HughlingsJackson believes that epileptiform seizures occur from localinstability induced by plugging of vessels (embolism orthrombosis).

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ST. GEORGE’S HOSPITAL.A CASE OF PERFORATING ULCER OF THE DUODENUM.

(Under the care of Dr. BARCLAY.)IN a recent number (Feb. 18th) we published a case of

perforating ulcer of the duodenum which occurred at thishospital. Dr. Cavafy favours us with the following reportof a second case, which differs widely in its clinical aspectsfrom the first, though pathologically precisely similar.George G-, aged fifty-six, admitted in the evening of

Feb. 18th, stated that, with the exception of epigastricpain, increased by taking food, which he had suffered forthe last three weeks, he had always had good health. The

pain had not been very severe, and had not incapacitatedhim for work. On the day of admission he had taken breadand cheese for dinner in the middle of the day. The meal wasfollowed by the usual slight epigastric pain, and he thoughtnothing of it. But a little before 6 o’clock, while walkingin the park, he was suddenly attacked by extreme violentpain in the belly, and was at once brought to the hospital.On admission, he was found to be a well-built, powerfulman. He had intense pain, which was much increased onpressure, and was referred to the lower part of the abdomen,which was flat and very hard. He was sweating profusely.His pulse was 80. The bowels had been open twice on thatday, and there had been no sickness. He was ordered some

brandy, with half a drachm of laudanum. This he vomitedat 7 P.M. He was injected subcutaneously with half a grriinof morphia, and, perforation being suspected, everythingwas administered by the rectum. At 9.30 he was under theinfluence of morphia, the pupils being contracted; but thepain was still severe. On the 19th there had been no freshsickness; the bowels had not been open; the tongue waRslightly furred; the pain was pretty general, but was nowmost severe in the epigastric region; the abdomen wasslightly more distended, but still very hard. (He had takenone grain of opium every four hours since midnight of the18th.) The pupils were contracted; the urine was veryhigh-coloured and albuminous. At 10 P.M. he was in a,

state of collapse, still conscious, but pulseless, with coldextremities, contracted pupils, and continued pain. Atabout 3 A.M. he passed into a state of violent delirium,which necessitated his being held down in bed, a,nd coii-tinued till death occurred at 7 A.M. on the 20th.At the post-mortem, Dr. Whipham found miliary tubercle

and excess of fibrous tissue at the apex of the right lung.There were dilatation and atheroma of the arch of the aorta,turbid yellow fluid, and much recent lymph in the peri-toneum, coating the liver and stomach. In the first portionof the duodenum, a little beyond the pylorus, and on theanterior surface, was a rounded perforation, with clear-cut,edges, a little larger than a pea. On laying open the gut,this was found to have been caused by a small ulcer, wbo8eedges were not thickened, and of which the diameter wana little greater than that of the pei-for&tion. No other ulcepexisted,

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