On the approach of warm weather, in June, the violence of the symptoms increased. Paroxysms of dyspnœa occurred more frequently, and were more distressing. They commenced with symptoms of slight febrile affection, such as hot skin, hard, frequent, and more irregular pulse, disordered tongue, loss of appetite, and derangement of the digestive functions. This kind of paroxysm lasted two or three days. Evacuations of blood from the nose and hæmorrhoidal vessels, which before rarely occurred, became frequent; a fulness at the upper and right side of the abdomen was sometimes perceptible, formed apparently by temporary enlargement of the liver; the difficulty in ascending an eminence increased sensibly. In the intervals of these attacks, which were variable, but generally continuing ten or twelve days, the strength was frequently good, and accompanied by a great flow of spirits, and an aptitude, or rather ardour, for business. Such was the course of this complaint until the latter part of August, when a very severe paroxysm occurred. It commenced, like the former, with febrile symptoms, but those more violent than before. The countenance became high coloured; the dyspnœa excessive, and rendered almost suffocating by a slight movement, or attempt to speak; the pulse hard, very irregular, intermittent, and vibrating; and the digestive functions were suspended. These symptoms soon increased to the highest degree. The respiration was so distressing, as to produce a wish for speedy death; the eyes became wild and staring. No sleep could be obtained; for, after dosing a short time, he started up in violent agitation, with the idea of having suffered a convulsion. During the few moments of forgetfulness, the respiration was sometimes quick and irregular, sometimes slow, and frequently suspended for the space of twenty five, and even so long as fifty seconds. At the end of three days the febrile heat was less permanent; the red colour of the face changed to a death like purple; the hands and face were cold, and covered with an adhesive moisture; the hardness of the pulse diminished, and a degree of insensibility took place. I seized this opportunity to examine the region of the heart, which had not been done before, from fear of alarming the active and irritable mind of the patient. The heart was perceived palpitating, obscurely, about the 7th and 8th ribs; its movements were very irregular, and consisted in one full stroke, followed by two or three indistinct strokes, and sometimes by an intermission, corresponding with the pulse at each wrist. The pulsation was felt more distinctly in the epigastric region. During this paroxysm a recumbent posture was very uneasy, and the patient uniformly preferred sitting in a chair. When the recumbent posture was assumed, the head was much raised, inclined to the right side, and supported by the hand; the knees were drawn up as much as possible. He could not bear an horizontal posture; nor did he ever