In the case of an elderly lady, ill with pneumonia and bronchitis mixed, I distinguished, on the right side, immediately under the clavicle, the râle crépitante; but, rather lower down, sounds like the chirping of a bird, an effect probably owing to spasmodic contraction of the minute branches of the bronchia, arising from inflammation. The other side of the chest afforded indications of free but noisy respiration. In addition to general bleeding, twelve leeches of full size were applied to the right side with great advantage. On the following day, the chirping sounds were lessened, and afterwards yielded entirely to further general and local bleeding. Instead of the chirping sound, we sometimes find that which is aptly compared to the cooing of the turtle dove. It is certain that the diseases of the heart form a much more delicate and difficult study with the stethoscope, than those of the lungs. In our ordinary means of investigation, it often exceeds our best powers of discrimination, to distinguish satisfactorily between functional and structural disease; and this difficulty, I apprehend, will not be removed by the use of the stethoscope, although I am well persuaded it will be very materially lessened. Both humanity towards the patient, and a regard for our own reputation, demand that we should use very great caution in forming our opinion on these occasions, and still greater in pronouncing it. Inordinate action of the heart arises from many influential causes, both of a moral and physical nature. Nervous palpitation is of common occurrence. Intermission of pulse is not unfrequent; but I have had occasion to see most experienced practitioners mistaken concerning the true nature of this affection. It occurs as a sympathy with a morbid state of the brain, the stomach, and also the liver; but most frequently, according to my observation, when the stomach of an individual of nervous constitution is disordered with permanent indigestion. The most remarkable cases of intermittent pulse which have occurred in my practice, have been connected with faulty action of the digestive organs, and of the liver especially, in gouty persons. We know how remarkably the gout affects the nervous system; and I can scarcely offer a stronger proof of it, than this kind of influence upon the heart; for although we meet with examples of the same kind of irregular action, in a disordered state of the digestive organs, in persons free from all disposition to gout, yet in such instances it is neither so permanent nor so remarkable.