It is very odd that I never had two of my severe headachs on two successive days; that they never make me look the least pale or yellow. Their progress is exactly similar: I am at first heavy and dull, then headach comes; then I feel sick, then I am sick: the produce of the operation is very acid, or very bitter; then I get better, and go to sleep, but in a quarter of an hour I wake worse, and so on, every half hour, until about four in the morning, when I gradually get better, and invariably wake quite well".

By a steady perseverance in the plan of diet and medicines prescribed for him, he found considerable alleviation, until April 1825, when he complained of having a return of his old headachs, with their usual severity; but he had relaxed in the strictness of his diet: and he adds: "I think, by more care in future, I shall be able to keep them in check; but I ought to state that I now suffer from a sense of weight and oppression, chiefly after meals." On the 18th of May he had a most violent attack, owing to having eaten a mince pie, and his subsequent letters complain of a listlessness and want of energy, which rendered him incapable of the slightest exertion. I expressed a wish to see him, and he arrived from Ireland on the first of June; the journey had been of service to him, and I found him much thinner, but better than I had expected. His numerous friends in London, anxious to pay that respect which his talents and urbanity so justly commanded, poured in their invitations, so that to expect obedience to any plan of regimen was not to be calculated upon. He left London, and proceeded to Leamington, where he unfortunately, by the explosion of the fowling piece, lacerated his little finger, and was compelled to suffer its amputation.

His health declined under this operation; he lost flesh, experienced increased headachs, and was so ill as to induce his friends to call in the aid of a popular practitioner in that neighbourhood, under whose superintendence he took drastic doses of scammony, not only without relief, but with an evident aggravation of the symptoms. He became thinner, and more than proportionally reduced in strength; so much so, that he found himself incapable of horse exercise: he suffered severely from constant nausea and oppression. In this state he continued, until his bowels, for the first time since the commencement of the disease, exhibited signs of torpor. "From a daily pill of camboge, scammony, aloes, and colocynth," says he, "I was obliged to increase the dose to four, and at last to discontinue them as entirely inefficient; and medicine having become as necessary to me as food, my medical attendant in Ireland has contrived a more active combination, which I take daily; but I fear that I shall be obliged either to increase its dose, or supersede it by one still more powerful, as I find that this is even losing its effect." His bowels at length became so torpid, that the most powerful drastics failed in their operation; his strength was daily declining; scarcely a day passed without headach and sickness: he suffered, during the night, from most violent cramps in his legs.

In the middle of December I received a letter from him, which was nearly illegible; and he states that he can scarcely see his hand, not from dizziness, but from an indistinctness of vision, which continues without any amendment during the day. His vision at length became so imperfect, that he could no longer correspond with me; I then urged the necessity of his once more coming to town - a proposal which he eagerly embraced; but such was his weakness, and so severe his sickness, vomiting without any cessation for forty-eight hours, that he was many days on the road. His face, hands, body, and legs swelled to a considerable degree, and he experienced great difficulty in breathing. As soon as he arrived in town, I immediately proposed a consultation. His bowels had not been moved for ten days, and every medicine given for that object had failed in its effects: this circumstance, connected with the fact of his deficient vision, which now rendered him incapable of recognising his friends, or even of distinguishing the window-frames, induced me to suspect that all the symptoms of this unfortunate case were to be referred to some disease in the brain. Sir H. Halford, Dr. Maton, and Dr. Warren met me in consultation.

The first great indication to be fulfilled was the evacuation of the bowels; he had already, by my directions, taken ten drops of the oil of the Croton Tiglium without effect. He was now directed to take twenty grains of calomel, with five grains of scammony; and a dose of the infusion of senna, with jalap and a neutral salt, every hour until an evacuation was procured. After some hours the bowels answered, and a perfectly healthy and figured motion was obtained. The vomiting was appeased by effervescing draughts; and a trial of the hydrocyanic acid was proposed. He was cupped, and blistered at the back of the head; but his vision grew daily more obscure: his headach was relieved, but he constantly experienced a sense of weight and uneasiness in the region of his stomach; his pulse was regular, but hard, and rarely less than a hundred beats in a minute. In this distressing state he remained for ten days; when I was suddenly called to him in the middle of the night, in consequence of a violent dyspnoea which had seized him. I found him in a state of apparent suffocation, and immediately requested the attendance of Mr. Keate, in order that some blood might be abstracted from the arm. He lost sixteen ounces, but no relief was afforded by the operation.

Dr. Maton saw him shortly afterwards with me: haemorrhage had taken place from the lungs, and he died at two o'clock, after the failure of the methods usually adopted in such an exigency. What was the nature of the disease? I confess that I had long considered the brain as its seat; and I explained the dyspnoea from a deficient supply of nervous energy, his symptoms bearing a striking analogy to those which were produced by a division of the eighth pair of nerves. The result, however, of the dissection, will throw some light upon this obscure and interesting case. Upon inspecting the abdominal viscera, not the slightest trace of disease could be discovered; the stomach was larger, and the diameter of the intestines smaller than usual, but there was no other appearance worthy of notice. On opening the thorax, the lungs appeared so gorged with blood, as almost to resemble the spleen in texture; they were emphysematous in several places. The heart was apparently healthy in external appearance, hut of a large size; upon making an opening into the right auricle and ventricle, the cavities were morbidly dilated, so as to constitute what has been termed passive aneurism: their parietes were not thickened. The left ventricle was also unusually large: the valves were in a healthy condition.

Upon opening the head, the structure of the brain and its membranes were found in a perfectly healthy state, but without the usual presence of blood. The substance of the brain itself was perfectly blanched, and, upon cutting into it, the usual spots of blood were not produced. This organ, therefore, although not injured in structure, must have been unfitted for the performance of its functions from a deficiency of blood; in consequence, probably, of the feeble action of the heart. The history of this extraordinary case will admit of much physiological speculation. That the heart was the primary seat1 of the disease, appears to be the most probable conjecture; the loss of vision must have arisen from a deficient circulation through the brain; and to this also we are to attribute the obstinate state of the bowels. The derangements of the stomach may be referred to its sympathetic relations to the heart, or brain. The gorged state of the lungs may be accounted for, either by the imperfect action of the heart, or by the deficiency of nervous energy; for a similar appearance is observed in cases of narcotic poisoning, where the death of the animal takes place from the destruction of the powers of the brain.

I have lately met with a case of diseased heart, in which the patient complained of a similar imperfection in his vision; and he died in consequence of pulmonary haemorrhage. I had no opportunity of examining the body.

1 I have learnt, since his death, that the pulsations of his heart frequently produced a considerable noise in bed, but he was himself unconscious of it, and never experienced the least unpleasant feeling in his chest; nor did the pulse, or any other symptom, indicate disease in that organ.