568 PRACTICE OF PHYSIC. 



head to give more freedom to the thorax, and particularly to 

 give an opportunity to the action of those muscles which fix the 

 upper ribs and pull the inferior ones upwards. 



" 2. The determination to the lungs is especially expressed 

 by any Pain about the thorax ; if that pain is fixed in one side, as 

 between the sternum and scapula?, it is an evident symptom of 

 pleurisy, or peripneumony ; but where there are only wander- 

 ing pains about the thorax, though they are not sufficiently ex- 

 pressive of these phlegmasiae, they are marks of such deter- 

 minations to the lungs as nearly approach to them. 



" 3. The uneasiness of a recumbent or horizontal posture is 

 especially a mark of some difficulty in the transmission of the 

 blood through the lungs. The position of the body has a con- 

 siderable effect upon various internal functions, but upon none 

 more considerable than upon that of respiration, so that a re- 

 clining, recumbent, or horizontal posture of the body makes a 

 considerable difference in this. For the particular enlargement 

 of the diaphragm is favoured by the erect posture, while in all 

 other positions it is more difficult ; and there is hardly any pos- 

 ture of the body which does not, in some measure, impede the 

 action of the intercostal muscles. In ordinary cases this does 

 not affect the respiration much ; but when it does so to a con- 

 siderable degree, this is a mark of still more considerable ob- 

 struction taking place. When this merely amounts to an un- 

 easiness in lying, and is removed by change of posture, it is 

 not so considerable, but when it is not so easily removed, and is 

 fixed in one particular place, it is a still more clear mark, not 

 only of a general difficulty in the passage of the blood through 

 the lungs, but of that difficulty being more considerable in one 

 portion of them than in another. This is the decubitus diffi- 

 cilis of authors, when the affection is thus particular, and espe- 

 cially when it increases the anxiety and perhaps the cough 

 which happens to accompany it. This leads me to consider, 



" 4. The principal mark of an increased determination to the 

 lungs, viz. the presence of Cough and of catarrhal symptoms. 

 How an application of cold gives a determination to the mucous 

 glands in general, and to those of the bronchia more especially, 

 it is not my business here to explain ; but certain it is in fact, 

 that the application of cold operates in this way. This may be 



