CHAPTER VIII.

IN June 1839, Dr. Hope published the third edition of his Treatise on Diseases of the Heart. It was illustrated by a few plates, which, like the Morbid Anatomy, were drawn under his own immediate superintendence, and finished by himself, so as to ensure anatomical fidelity. This edition contained much additional matter, derived from the constant investigations of the author since the appearance of the preceding editions. The intricate subject of diseases of the valves received particular illustration, and the diagnosis of these diseases was so simplified as to divest it of much of its difficulty. Dr. Hope offered to teach the diagnosis in ten minutes to any person who had a previous knowledge of auscultation. This offer having found its way into the medical journals, was laughed at as an idle boast. Dr. Hope, accordingly, selected six of the pupils of St. George's Hospital, gave them his instructions during ten minutes, and then left them with half-adozen cases which he had previously examined, and of which he had written the diagnosis. Every necessary precaution was taken to prevent the pupils from holding any communication with each other. Notwithstanding, their diagnoses, when compared, agreed with each other, and with that of Dr. Hope. The previous editions of the Treatise on the Heart had been declared to be the best on the subject hitherto written. They

were completely thrown into shade by the present one, which must confer lasting reputation on its author. Soon after its publication, his modesty produced rather a ludicrous mistake. He never seemed to estimate it above its predecessors; but when complimented by Dr. Latham on its being a "great book," Dr. Hope, with simplicity, began to apologise for the length to which his subject had led him, and only feared that Dr. Latham considered him too prolix.

In the earlier part of this work, it has been mentioned that Dr. Hope was descended from a family remarkable for longevity, and he had reason to believe that he inherited their constitution. The laborious life which he had led would have long since destroyed a person of feeble frame; but his health remained unimpaired. In February 1836, he desired to insure his life, and in the declaration which he was required to send in, he says, that since infancy, he had never consulted a medical man, except Dr. Chambers once, for an attack of lumbago in 1833. As some members of his family had died of consumption, his chest was carefully examined by Dr. Mac Leod and Dr. George Burrows, and neither of these gentlemen could detect any disease. Hitherto he had never had a cough; but in May 1836, when he had begun to find his duties at St. George's too laborious, he had a slight cough and pain in his side, which yielded immediately to a blister, and he considered himself entirely re-established. In the spring of 1837, he had an attack of

influenza, which settled on his chest, and from this period he was never free from a slight, hacking cough. It was an established maxim of his, that a cough, however slight, should not be neglected; and, therefore, from the first, he paid the greatest attention to the removal of his own. But he soon saw, that so long as he had the charge of above 400 patients at St. George's Hospital, all medicinal remedies would be in vain. His health improved or deteriorated in exact proportion as the work at the hospital was more or less arduous. Occasionally he was obliged to absent himself altogether; at other times he succeeded, with the sanction of his colleagues, in obtaining assistance from the senior pupils; and, on these occasions, his health manifestly improved. In 1838, his symptoms were aggravated by the painfully excited state of his nervous system, which produced a distressing intolerance of noise, and great difficulty in fixing his attention to any subject. It has been shewn how great had been his powers of abstraction; but the case was now totally reversed. When he came home the whole house was hushed into perfect stillness: the slightest sound was distressing-nay, he was sometimes obliged to take off his own shoes, because, as he moved in his chair, he heard them creak. In such a state of nervous excitement it may be supposed how painful was the effort of seeing 140 patients in rapid succession; and yet his high sense of religious responsibility would not permit him to do his work

negligently. A professional gentleman of considerable talent who had many opportunities of noticing him, recently remarked, that, while there are many modes of prescribing for patients, varying according to the attention and ability of the practitioner, none but a superior mind could fully estimate the care, the science, and the intellectual labour which Dr. Hope expended on his out-patients at St. George's. Often, after remaining thus occupied for nearly four hours, he used to return home completely exhausted, and unable to call on any private patients.

In August 1838, he went to Scotland, and took the opportunity of consulting Dr. Abercrombie, whom he happened to meet at Inverness. Dr. Abercrombie gave a decided opinion on the necessity of avoiding study and fatigue; but, not having examined Dr. Hope's chest by auscultation, he could not pronounce on the state of the lungs. After a month's relaxation, Dr. Hope returned to town considerably better; but the distressing symptoms were soon renewed by the recurrence of their exciting cause, the care of the numerous out-patients of St. George's. In compliance with the entreaties of his family he consulted Sir James Clark, who examined his chest, and forming an unfavourable opinion, recommended his going abroad. He told Sir James that it was not in his power to do so, and he was then desired to subject himself to as little fatigue as possible. No one who knew the particulars of his position as assistant physician to St. George's, and

the risk which he incurred, by absence, of losing his election to the physicianship, could have urged him to leave town. He saw plainly that he must either remain at his post, or abandon the idea of being physician to the hospital, and with it the hope of eminence in his profession. It may be asked, with some appearance of truth, what is a profession when weighed against life? The answer is obvious-that, to a man under 40 years of age, with a family, and without an independent fortune, the loss of a profession involves the loss of much that renders life dear. After deliberate consideration he saw no alternative but to continue as he was till the spring; and then, should his position remain unchanged, he made up his mind to apply to the Board for regular assistance. In expectation of being obliged to give the Board an account of the nature and amount of the work of which he complained, he drew up the following document. This statement was shewn privately to some of his colleagues, and, finally, laid before the Medical Committee.

"On my election to the office of assistant physician at St. George's Hospital, in November 1834, the men and women out-patients attended promiscuously on the same day; there was a constant rush at my door to obtain admission; the strongest succeeded, and the weakest were often long detained, to their great detriment and dissatisfaction. The patients' books were in boxes, out of which the physician had to hunt