. Transactions de l'Association clinique et climatologiques américains.. disproportionnées à celles de respiration calme, et valeurs relatives ont toujours été systématiquement figurant principal. En raison de cette caractéristique et le subjectif symptomsthe moyenne a été réduite à o, ou un peu moins. Thisreduction réduit le sentiment de fatigue quelque peu, et thepulse, qui atteignait en moyenne 90, a chuté à un taux régulier de 80 semaines. aftertwo L'expectoration, de petite quantité, mais littleinfluenced a été. Les signes physiques dans le lobe supérieur droit plutôt havediminished. L'état général de l'patienthas considérablement

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. Transactions of the American Climatological and Clinical Association.. isproportionate to those of quiet breathing, andtheir relative values have always been consistently main-tained. Because of this feature and the subjective symptomsthe mean pressure was reduced to o, or a little less. Thisreduction lessened the sense of fatigue somewhat, and thepulse, which had averaged 90, fell to a steady rate of 80 aftertwo weeks. The sputum, small in amount, was but littleinfluenced. The physical signs in the right upper lobe havediminished somewhat. The general condition of the patienthas materially improved, and apprehension has gone. Skia-grams (figs. 1 and 2) show a marked displacement of theheart after the refill, which is materially more marked onexpiration than on inspiration. There is a lateral adhesionseen about the fourth rib, but no diaphragmatic adhesion.The fluoroscope shows the greatest movement of the heartwith respiration when there is a large amount of gas. Thelung is not completely collapsed immediately after a refill. Fig. I.—Full inspiration.. Fig. 2.—Full expiration. Movable Mediastinum.—Skiagrams of chest taken third day afterApril 3, 1915. See Case I, Chart I. refill of MOVABLE MEDIASTINUM AND THE MANOMETER l6l The yielding of the mediastinum, therefore, makes completecollapse a doubtful possibility or possible only at considerablerisk. The phenomenon was present during the first five fill-ings, and then disappeared until the ninth filling, since whichtime it has been usually present (see Chart I, b, c, d, ).Through the fluoroscope the diaphragm was seen to rise in ajerky manner when the breath was held on inspiration. Case 2. — Movable mediastinum becoming fixed.(Chart II.) No. 27, female. Right lung collapsed for severeand long-standing disease. Left lung : slight disseminateddisease throughout upper lobe. September 21, 1914.—Initial operation, adhesions present, 200 c.c. gas. Two days later gas easily introduced, two setsof stationary point

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