unger look than when he laid aside
his narcotic."

_April, 1834._

The case of Mr. L. B., a shoemaker, now about fifty-two years of age,
exhibits strikingly the injurious effects of tobacco. About fourteen
years ago, he consulted me on account of dyspepsia, obstinate
costiveness, and palpitation of the heart, which symptoms had existed
for several years. The palpitation he had observed about seven years
before. In a small degree it occurred almost daily. For years a slight
fluttering was generally felt, in the morning, for a short time after
breakfast, which compelled him to sit still, avoiding mental as well
as muscular exertion. After an hour or more, he was better. He was,
besides, subject to severe paroxysms of palpitation, occurring at
irregular periods. Six or seven of these took place in a year. These
turns were excited under stomach irritations or oppression from
indigestible food. They came on instantaneously, and often left in
a moment; 'the pulse was nothing but a flutter.' So great was the
prostration, that, during the paroxysm, he was obliged to lie still
upon the bed. The length of the paroxysm was various; sometimes an
hour, sometimes several hours.

He was in the habit of using tobacco in all its forms of cud, cigar and
snuff; he drank tea and coffee freely, and spirit and cider moderately.
I advised him to the entire disuse of tobacco, tea, coffee, and all
other drinks, save water, and to live on plain and unstimulating food.
He followed the advice in regard to drinks, in so far as to confine
himself to water, and threw away the cud and cigar, but continued to
take snuff. Under this change his health was improved, and the turns of
palpitation were less frequent, and generally less severe. Two years
afterwards, he abandoned flesh meat as an article of diet, and still
indulged himself in the habit of snuff-taking. In this way he continued
for about six years, his general health being considerably improved; he
was subject, however, to an occasional attack of palpitation. At length
he had a paroxysm, which was so terribly severe and protracted, as to
keep him nine hours and an half motionless upon his back, under the
incessant apprehension of immediate dissolution. In the course of this
nine and an half hours he made up his mind to take no more snuff. He
has kept his resolution, and has not had an attack since, now about six
years. He says he has sometimes felt a slight agitation or tremor, but