_ he different kinds of fluids met with in the chest, and requiring 
to be drawn 6ff by this operation, are serum, blood, pus, and air. 
The symptoms of each of these may vary according to tie nature of 
the disease, or of the accident giving rise to their formation. But it _ 
is their effect on the motion of the heart and lungs, to which practi- 
tioners ought chiefly to attend ; and this will always depend more 
on the quantity than on the kind of fluid that is collected. 
~ Collections of serum in the chest are frequently combined with 
dropsy in other parts ; but we often meet with it asa local affection ; 
and it is in this case chiefly, that any advantage isto be expected from 
an operation. These collections may take place in either, or both, — 
of the cavities of the chest, and also in the enclosing membrane of — 
the heart. Distressful symptoms acconipany these collections ; but 
it requires much attention to ascertain their existence, and es ecially 
their situation, with sufficient precision to warrant an operation of 
such importance as tapping the chest. 
A patient who complains ef a sense of weight or oppression in the 
chest ; of difficult breathing ; of more uneasy sensations in one side 
of the chest, than in the other ; of being liable to sudden fits of start- 
ing during sleep, from fear of immediate suffocation; and if, along 
with these, he is distressed, with a frequent cough; if the pulse is 
small and irregular; and if a dry skin, scarcity of u:ine, swelled 
limbs, and other symptoms of dropsy take place, little doubt can re- 
main of water being collected in some part of the chest. A sense of 
undulation, as of water passing from one part of the breast to an- 
other, is sometimes observed by the patient, on rising suddenly from 
a horizontal posture ; and this may serve to assist in ascertaining the 
nature, as well as location, of the disease. In examining the chest, 
the patient should be uncovered. When the quantity of serum is 
considerable, it may be commonly discovered by placing one hand 
upon the front part of the ribs, near the breast bone, and striking 
with some force near the back bone with the other ; and if an indu- 
lation is pereeived in one side of the chest, and not in the other, the 
seat of the disease is thereby obvious. But when the quantity of 
In this case, a per- 
continued collections of serum, the seat of it may some- 
When the disease is in the membrane of the heart, nearly the same 
symptoms take place asin other parts of the chest. But in this case, 
_ itis observed that the patient complains chiefly of the middle and left 
side of the chest; and it may be mentioned asa characteristic of this — 
‘shape of the disease, that a firm undulatory motion is perceived be~ 
tween the third, fourth, and fifth ribs, on every pulsation of the — 
ies ne above are the symptoms of serum, or water in the ch 
variations from these symptoms in — collections, are as fo 
a. 
