286 ASCITES COMBINED WITH HYDROTHORAX, SiC. 
The cavity of the abdomen was distended with a serous fluid, 
as limpid and almost as colourless as water ; and the cellular tex¬ 
ture of the mesentery and mesocolon was loaded with interstitial 
effusions of fluid of the same kind. The stomach and intestines 
themselves were sound. The liver and spleen were sound. The 
kidneys were unnaturally pale and tough: this was, in course, most 
remarkable in the cortical portions; the infundibula contained 
purulent matter. The bladder was empty : the stomach nearly 
full of indigested matters, mingled with the medicine recently 
given. 
Observations. 
Here is one more case of genuine pleurisy: the lungs, it is 
true, were found in a condition that would not warrant one to de¬ 
clare that they were absolutely free from any alteration of texture; 
at the same time, as far as their function was concerned, they might 
be called intrinsically sound : and, furthermore, what condensa¬ 
tion appeared was evidently recent, and certainly secondary and 
sympathetic to the pleurisy. 
In fact, it was a disease of the serous membranes; and I have 
regretted ever since, that I did not prosecute my examination into 
the head : had I, I have little doubt but that I should have found 
similar effusion into the ventricles of the brain. It was a compli¬ 
cated case in regard to the locality of the malady. It was a simple 
disease, pathologically considered; and this is by far the most 
rational and best view we can take of every disease. 
The kidneys probably grew pale from inaction : the serous ex- 
halents were robbing them of their rightful pabulum for secretion— 
the aqueous parts of the blood. 
The water within the belly, I should say, had been collecting 
for some time before any was effused into the chest. The pri¬ 
mary inflammation in the pleura ran too high for the secretion of 
water: lymph was there thrown out, while the sympathetic and 
lower action in the peritoneum simply produced a superabundance 
of secretion; after a time,however, the inflammation in the pleura 
abates—or perhaps subsides altogether and afterwards returns— 
and then it is that water begins to form within the cavity of the 
chest. 
Had this case not already run to an inconvenient and probably 
tiresome length, I should like to have coupled it with the one 
I have related in my published Lectures (Part II, p. 402), and 
with such others as I could find (I mean of ascites), and to have 
endeavoured, by collation of facts and circumstances, and legiti¬ 
mate deductions and conclusions, to have arrived at something 
approximating to a diagnosis of the presence of water within the 
