regular occupation of the mind had the effect of obviating the occurrence of any paroxysm of disease, as well of epilepsy, as of difficult respiration; and that a very sudden and disagreeable impression generally produced either one or the other. There were, indeed, independently of such circumstances, some occasional aggravations of those symptoms. Some nights, for example, were passed in sitting up in bed, under a fit of asthma, as it was called; sometimes the mind became uncommonly impatient and irritable; the body gradually emaciated; yet the appetite and digestive functions remained principally unimpaired; and persons around were not sensible of any material alteration in the condition of the patient.

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 lie on the left side, except a short time after the application of a blister. At the end of the fifth day his sufferings abated, but the sudden affusion of a small portion of a cold liquid on the head produced a severe fit of epilepsy. This was followed by a return of the symptoms equally distressing, and more durable, than in the first attack[2].

This violent agitation gradually subsided, and was followed by a pleasant calm. The natural functions resumed their ordinary course; his appetite returned; his enjoyment of social intercourse was unusually great; and he amused and instructed his friends by the immense treasures of information, which his talents and observations had afforded him, and which, he seemed to feel, would soon be lost. At the end of September the feet began to swell, and after some time the enlargement extended up to the legs and thighs, and increased to an extraordinary degree; the abdomen next swelled, and, after it, the face. Toward the end of October there were some indications of water in the chest; there was a constant shortness and difficulty of breathing; the cough, till now rare, became more frequent and troublesome; the contraction of the thoracic cavity rendered the action of the heart more painful, to that beside an uniform stricture across the breast, he sometimes described a dreadful sensation like twisting of the organs in the thorax. He suspected the existence of water there, and was inclined to consider it as his primary disease, but was easily convinced of the contrary. At one time he had a suspicion of a complaint of the heart, and, although he had never heard of a disease of that organ, slightly intimated it to one of his friends, and mentioned a sensation he had experienced in the chest, which he compared to a fluid driven through an orifice too narrow for it to pass freely. In this month, beside the dropsical affections and increase of cough, he had occasional painful enlargements of the liver, frequent starting up from sleep, a slight degree of dizziness, a great disposition for reveries, and sometimes extraordinary illusions, one of which was, that he was two individuals, each of whom was dying of a different disease. This idea often occurred, and gave him much uneasiness. He was also afflicted with long continued frightful dreams, and sometimes a slight delirium.

After the use of much medicine, on the 6th of November, the effused fluids began to be absorbed, and passed out through the urinary organs with such rapidity, that on the 12th the dropsical enlargements had nearly disappeared. The pulse was much reduced, in hardness and frequency, by the medicine, and, as it fell, he became more easy. On the 10th the state legislature convened, and the call of business roused, like magic, the vigor of his mind; and the symptoms of his disease almost disappeared. During this session he made little complaint, dictated many important communications, and attended to all the duties of his office, without neglecting the most minute. As soon as the legislature adjourned, he declared, that his work was finished, and that he had no desire to remain longer in this world. He entreated that no farther means should be used to prolong his existence, and immediately yielded himself to the grasp of disease, which appeared waiting with impatience to inflict its agonies.

From this moment the distressing difficulty of breathing had very slight remissions. The consequent disposition to incline the superior part of the body forward, for the purpose of facilitating respiration, increased so much, that he frequently slept with his head reposed on his knees. The cough became occasionally very violent, and was always attended with an expectoration of a brown coloured mucus, sometimes tinged with blood. The abdominal viscera lost their activity. The face was sometimes turgid