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 dyspnœa 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 in the most comfortable nights he passes, he sits up once in an hour or two. The appetite is keen. The legs begin to swell again. Some organic disease of the heart exists in this case. The indistinctness of the palpitations, the want of hardness in the pulse, and the slow progress of the disease, indicate a loss of power in the heart, the effect of the distention and thinness of its parietes. The irregularity of the pulse affords some reason to suspect disorder of the aortal valves, which is not yet very considerable. ENUMERATION _of the principal morbid changes, observed in the organization of the heart, in the preceding cases_. Enlargement of the volume of the heart, or aneurism.[12] Increase of the capacity, or aneurism of the right auricle, } with of the right ventricle,} thickened, of the left auricle } or thin, of the left ventricle, } parietes. of the aorta, with thickening of its coats. Fleshlike[13] thickening of the mitral valves. of the aortal valves. of the aorta. Cartilaginous thickening of the internal membrane of the heart, and generally of its valves. Ossification of the parietes of the heart. mitral valves. aortal valves. aorta. coronary arteries. [Footnote 12: Morgagni uses this term, which he borrows from Ambrose Pare, to express dilatation of the cavities of the heart. It seems to be as applicable to the dilatation of the heart, as to that of an artery. I have therefore adopted it in this enumeration.] [Footnote 13: The term fleshlike is employed to express that roughness of the valves, which somewhat resembles flesh in its appearance, but which is very different from the thickening of the parietes of the heart.] ENUMERATION _of the principal morbid appearances, observed in these cases of disease of the heart, which may be considered secondary_. IN THE CAVITY OF THE CRANIUM. Inflammation of the meninges. Water between the meninges. Water in the ventricles. IN THE PLEURA AND ITS CAVITY.