t, and pain in the region of the heart, which increased till
within six or eight months, since which the beating has been
stationary, and the pain has much increased. In the course of the last
summer, dyspnoea, on using exercise, and especially ascending any
eminence, commenced. This has greatly increased, so as to render it
almost impossible for him to go up stairs. His countenance is turgid,
and uniformly suffused with blood; his eyes are bright and animated;
his lips livid. The pulsation of the heart cannot be felt on the left
side, and is barely perceptible on the right side of the sternum, and
in the epigastric region. When he is distressed with fits of dyspnoea,
he feels something as if rising to the upper part of the thorax, and
the heart then seems to him to be beating through the ribs. I have not
witnessed any of these paroxysms. The inferior extremities and abdomen
have been swelled about three weeks. When in bed, he has his head and
shoulders elevated, and, upon the attack of his paroxysms, sits up and
inclines his head forward; but he keeps from the bed as much as
possible. In his sleep he is apt to start up, suddenly, in distress,
especially when he first slumbers. His dreams are often frightful,
and, when awake, he is affected with reveries, during which, though
conscious of being awake, strange illusions present themselves. At
intervals he seems slightly delirious. He has a violent cough, with
very copious expectoration of thick mucus. He often suffers from
severe head-ache, and the least exercise produces dizziness.

This man has a very robust frame of body, and has been accustomed to a
free use of ardent spirits, and of opium, of which he now takes about
twelve grains in a day. His appearance is such, that, on a slight
survey, one would not suppose him diseased, but, on observing him with
a little attention, a shortness and labour of respiration are
perceived, with some interruption in speaking, and a frequent catching
of the breath, or sighing.

April. Since writing the above account, the dropsical collections were
absorbed, and the palpitations and other symptoms moderated, so that
he considered himself nearly well, and attended to his usual business.
Within a few days, however, the symptoms have returned with more
violence. The dyspnoea is at times very distressing; the pulse more
irregular and intermittent; the palpitations are more constant. His
sufferings from lying in bed are so increased, that