612 PRACTICE OF PHYSIC. 



and attached to particular parts of the internal surface of the 

 pleura. 



MDCXCIX. From the collection of water being thus in 

 various situations and circumstances, symptoms arise which are 

 different in different cases : and from thence it becomes often 

 difficult to ascertain the presence and nature of the affection. 

 I shall, however, endeavour here to point out the most common . 

 symptoms, and especially those of that principal and most fre- 

 quent form of the disease, when the serous fluid is present in 

 both sacs of the pleura, or, as we usually speak, in both cavi- 

 ties of the thorax. 



MDCC. The disease frequently comes on with a sense of 

 anxiety about the lower part of the sternum. This, before it 

 has subsisted long, comes to be joined with some difficulty of 

 breathing ; which at first appears only upon the person's mov- 

 ing a little faster than usual, upon his walking up an acclivity, 

 or upon his ascending a staircase : but after some time this dif- 

 ficulty of breathing becomes more constant and considerable, 

 especially during the night, when the body is in a horizontal 

 situation. Commonly, at the same time, lying upon one side is 

 more easy than upon the other, or perhaps lying upon the back 

 more easy than upon either side. These circumstances are 

 usually attended with a frequent cough, that is at first dry, 

 but which, after some time, is accompanied with an expectora- 

 tion of thin mucus. 



With all these symptoms, the hydrothorax is not certainly 

 discovered, as the same symptoms often attend other diseases of 

 the breast. When, however, along with these symptoms, there 

 is at the same time an oedematous swelling of the feet and legs, 

 a leucophlegmatic paleness of the face, and a scarcity of urine, 

 the existence of a hydrothorax can be no longer doubtful. Some 

 writers have told us, that sometimes in this disease, before the 

 swelling of the feet comes on, a watery swelling of the scrotum 

 appears : but I have never met with any instance of this. 



MDCCI. Whilst the presence of the disease is somewhat uncer- 

 tain, there is a symptom which sometimes takes place, and has 

 been thought to be a certain characteristic of it ; and that is, 

 when soon after the patient has fallen asleep, he is suddenly 



