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When air gains access to the pleural cavity a displacement of the mediastinum frequently takes place. This mobility of the mediastinum depends on the flexibility of its tissues, the lack of pleural or pleuro-pericardial adhesions, the pressure created within the pleural space and the size or volume of the pneumothorax. The entire mediastinum may be shifted or a part of it. Thus, only the upper or only the lower portion of it may be displaced. Besides these variations in the position of the mediastinum, a protrusion of the pneumothorax cavity through the mediastinum into the sound, or untreated, side, occasionally takes place, thus forming a culdesac, or hernia. The most frequent point for a hernia of this nature to occur is in the upper anterior part of the mediastinum between the first and third ribs. Here the right pleura and the left pleura come in closest contact and are separated

In an article recently published inThe Journal, I1reported the discovery that it was possible to abolish all breath sounds as heard over the larynx and the chest by a voluntary separation of the vocal cords. The discovery was entirely original on my part, yet it seemed incredible that so simple and easy a procedure as the voluntary widening of the rima glottidis should never have occurred to any one until the present time. A search through the literature now shows that I had been anticipated by nearly a century. At the session of the Academie royale de medecine, June 10, 1834, Beau2described a case in which he heard a very marked bronchial souffle at the level of the subspinous fossa, in a patient with "effusion of the right pleura" who was breathing noisily. Wishing to know how much the noise of respiration contributed to produce

This paper presents a statistical analysis of 37 patients with empyema treated at the Children's Hospital, Washington, D. C., from Jan. 1, 1943 to April 1, 1948, with observations on the etiology, diagnosis, therapy and complications of the disease. The criteria used in selecting cases for this study were the presence of purulent pleural fluid and positive bacteriologic findings resulting from culture of this fluid, either during life or on postmortem examination. The diagnosis was made on autopsy specimens in eight instances; two of the deaths having followed surgical procedures. Those cases having no bacteriologic proof and those following traumas or the aspiration of foreign bodies are excluded from the series. The right pleura was involved in 21 instances (56.7 per cent), the left pleura in 13 instances (35 per cent) and both pleurae in three instances (8 per cent). During this period of five years and three months, the

The problem of differentiating grossly bloody fluid in the pericardiac sac from intracardiac blood during a pericardicentesis may sometimes be difficult. Fortunately, this situation seldom occurs, but, when it does, it is usually in a patient who is acutely ill and can poorly tolerate loss of an appreciable quantity of blood as the result of unintentional aspiration of blood from the heart. In the following abridged case report, such a distinction was rendered difficult by the anatomic changes caused by the underlying disease and the effects of therapy. The use of the procedure described below as an aid in determining the source of the blood obtained at pericardicentesis was arrived at by fortuitous circumstances, and its simplicity was sufficiently appealing to warrant publication. REPORT OF A CASE A 17-year-old white boy had an extensive lymphoblastic lymphoma of the mediastinum and right pleura of three months' duration at the time of