de. The action of the heart
under the stethoscope gave rather an uncertain indication as to the
state of that organ, for though the sound was evidently communicated to
the ear, as being transmitted through a fluid, and not the heart
striking the ribs, still, from the very general dulness in the left side
of the chest, it was exceedingly difficult to decide whether this
obscurity arose from effusion into the pericardium, or from effusion
into the cavity of the chest. There was one remarkable symptom
manifested in this case,--that though the heart's action was to the
observer feeble, the patient's sensations were as if the pulsation was
very strong, and painfully difficult to bear, and this peculiar feeling
to a great extent prevented him from sleeping. I cannot record this case
without the painful recollection of this poor man's sufferings. For six
months previous to his death, the dyspnoea and palpitation attendant
upon his disease were of such a severe character, as to prevent him at
any time lying down; and his sensations would not even permit his
maintaining the sitting position, for he found it necessary to get upon
his hands and knees, as the only posture affording any alleviation to
his uneasiness. This peculiarity in the cardiac action was such, that,
as he expressed it, "he lived in continual dread of death," and this
being ever present to his mind, he was for weeks known almost never to
close his eyes. He died exhausted, in November 1836; and there being
doubts entertained regarding some of the symptoms of his disease, he
requested that his body should be examined, which was done twenty-six
hours after his death.

_Post-mortem Examination._--The general anasarca gave the body a bulky
appearance. On raising the sternum, the ribs seemed very firm and
unyielding. The lungs were of a dark blue colour, and seemed at first
appearance to fill completely both sides of the chest. Towards the
sternal end of the ribs, on the left side, three or four of the
substernal or mammary glands were found enlarged and filled with black
fluid. The pleura pulmonalis had (where there wore no adhesions)
interspersed over it patches of false exudation, _of a dark brown
colour_. The lungs adhered extensively to the pleura costalis, and from
the character of the adhesions, they were evidently of some years'
standing. In both sides of the chest there was effusion to a
considerable extent of a dark-coloured fluid, resembling porter in
appe