r. Hamilton's
"observations," and by that which may be drawn from these cases, and
future investigations of the subject. It will perhaps hereafter appear
surprising, that derangements in the structure of so important an
organ as the heart should have been lightly estimated by very
respectable authors.

* * * * *

While concluding these observations, a case of this disease presented
itself, which comprehends so many of the symptoms, that I cannot
neglect an opportunity of recording it, especially as it exhibits the
complaint in an earlier stage than the others, with appearances
equally unequivocal. I may here be allowed to remark, that no cases
have been introduced which occurred before my attention was directed
to a close observation of this disorder, and that there are many
others, under the care of practitioners of eminence belonging to this
society, with symptoms perfectly well marked, which it has not been
thought necessary to adduce. In proof of this, reference may be had to
Dr. Warren, sen. who has a number of cases, and also to Dr. Dexter,
Dr. Jackson, and Dr. J. C. Howard.

A lady from the country, of a robust habit, whose age is about
thirty-four years, complains of uneasiness in the right side below the
edge of the ribs, sometimes attended with swelling, external soreness,
and a throbbing pain, which often reaches to the shoulder, and
produces a numbness of the right arm. She is rather uncertain at what
time her complaints commenced. About two years since she lost her
husband, and was left with but small means to support a number of
children. She became in consequence, much dejected. While nursing a
child, about a year since, she first was sensible of palpitations of
the heart, which, in about three months, were followed by dyspnoea
very much augmented by ascending an eminence; and profuse discharges
of blood from the mouth, first raised, she believes, by vomiting, and
afterwards by coughing. Evacuations of blood from the haemorrhoidal
vessels appeared about the same time, and occasionally since, till
within six weeks, during which time there have been no sanguineous
discharges, and this suppression has aggravated her other complaints.

The pulsation of the heart is felt most distinctly quite on the left
side of the thorax, where there is a painful spot; it is perceptible
also in the epigastric region. It is irregular and variable, at one
moment hard, strong, distinct, and v