[28] I once observed a similar condition in a young woman in St. George's Hospital. Each pulsation of the heart could be heard with great distinctness at a distance of two or three yards from the patient; during the paroxysms, there was the greatest difficulty of breathing; the countenance became anxious and livid, and a distinct thrill was communicated to all the arteries. After death, the countenance and upper part of the body were found livid from venous congestion. The lungs did not readily collapse when the chest was opened. The auricles of the heart were greatly distended with black blood; the inner surface of the left ventricle presented a white patch, of about two square inches in extent; the lining membrane of the aorta, for several inches, was of a bright red colour; this extended round one-third only of the circumference of the vessel. No other structural change could be found in the heart or vessels, which would account for the symptoms observed during life. _Post-mortem appearances._ The mucous membrane of the eyes, nose, and mouth, was red or violet, and covered by a very abundant thick mucus. The lungs were of a dark colour, with some black patches, but still crepitant. The left ventricle of the heart presented several brown stains, resembling ecchymoses, which penetrated into its tissue. Its internal surface was of the colour of lees of wine, offering a singular contrast to that of the right side, which, however, contained a hard fibrinous concretion, two drachms and a half in weight, of a light yellow colour, and resembling grease in appearance. This was of the same consistence throughout, everywhere free, with the exception of a portion of the size of a finger nail, which adhered to an irregular and apparently inflamed spot on the inner surface of the ventricle; no appearance of the injected fluid could be recognized in this clot. It was continued of the same colour and consistence into the pulmonary artery, and into the vena cava, the vena azygos, the axillary, and even the right jugular vein.