When the circulation is sluggish, owing to the inefficiency of the heart, the tissues become œdematous. In other words, lymph accumulates in the tissue-spaces. When the skin of a healthy person is pressed, it returns to its natural position as soon as the pressure is removed. If there is a tendency to dropsy—for ages the term “hydropsia” has been thus familiarly clipped—the finger leaves a pit behind it when pressed upon the skin. It is some little time before the lymph in the connective-tissue sponge readjusts the surface. Excessive escape of lymph from the blood, or its insufficient return into the blood, may also be the result of obstruction to the flow in the great veins. When the veins of the leg are varicose, the weight of the column of blood in the distended vessels impedes its circulation. After standing, the tissues about the ankle become œdematous. The œdema disappears on lying down. A hardening (cirrhosis) of the liver impedes the circulation of the blood which comes to it through the portal vein from the walls of the alimentary canal. The capillaries of the stomach and intestine are distended. Lymph accumulates in the abdominal cavity, producing ascites, another form of dropsy. It is almost hopeless to attempt to disentangle the various factors which disturb the balance between blood and lymph—excessive outflow from blood, deficient inflow from lymph, stretching of the endothelium of the capillary tubes, imperfect nutrition and consequent imperfect apposition of the endothelial scales, increased permeability of the scales. The exudation which accompanies inflammation would seem to be due to the diminished vitality of the endothelium rather than to a mechanical factor, such as increased blood-pressure in the capillaries, and their consequent distention. Ascites is, apparently, a purely mechanical result of the resistance offered to the passage of blood through the liver; but pleurisy, the accumulation of lymph in the space between the lungs and the chest-wall, cannot be explained in the same way. There is no undue pressure on the vessels in which the blood circulates through the inflamed pleura (the investing membrane of the lungs and lining membrane of the chest), yet the walls of the capillaries fail to maintain a proper balance between blood and lymph.