pleuritic effusion, and in the diminution of measurement; that of the condensed or left lung being 1-2 in. less than that of the right. In Beasley the whole movements of the left side, both costal and diaphragmatic, were annihilated, the left second rib alone moving, and the motion of that rib was exactly balanced, as it first retracted and then advanced 02 in. The lower end of the sternum advanced in Beasley, whose case differs from that of Shaw in this circumstance, and in the annihilation of the diaphragmatic movement.

The influence of the diaphragmatic descent in Smith caused, as has been seen, elongation and collapse of the lung and consequent falling in of the lower ribs; in Beasley, as the diaphragm did not act, the lung was not elongated, did not collapse, and did not fall in excepting at the second ribs. During a deep inspiration, the sixth rib fell in '05 in., the diaphragm then most probably descended, elongating the lung, and causing it to collapse. In cases such as this of Smith, when the expansion of one side of the chest is exaggerated, of the other diminished, the sternum moves a little towards the exaggerated or healthy side. This was pointed out to me by my pupil, Mr. Martyn; it is a circumstance that readily catches the eye, and is therefore of value in leading the attention to the cause of it.

Summary. When the whole of one lung is simply condensed, the movements of that side are either much diminished, annihilated or reversed, while those of the opposite side are increased. The motion of the diaphragm on the affected side, though restrained, is not annihilated, the unexpandable lung being lengthened by the diaphragmatic descent, and the diaphragmatic and intermediate ribs consequently often fall in during inspiration, while the superior ribs are motionless, or move outwards but a little. During a deep inspiration the retraction and rest of tranquil breathing give place on the affected side to inspiratory expansion, greater from the motion of the thoracic ribs, and of the diaphragm, than from that of either the diaphragmatic or intermediate ribs.

The cases of consolidation complicated with phthisis will be considered under that subject.

D.-Effect of phthisis on the movements of respiration.— The lungs in phthisis present so infinite a variety of conditions, that we must look for a considerable variety in the phenomena presented by the movements of respiration. It so happens that though I have observed a fair number of cases with the chest-measurer in the advanced stages of phthisis, I have not examined any with it in the early stages.

The whole of one lung affected.-Among the advanced cases, there are thirteen in which the whole of the most diseased lung presented unequivocal marks of disease. The wood-cuts at pages 440 and 441, taken from J. Boot, having tuberculous disease of the whole right lung, represent the position of the ribs and lungs and other viscera, before and after the inflation of the lungs. They show the great diminution in the expansibility of the diseased side. In this case very firm tendinous adhesions enveloped the lower lobes, and combined with tuberculous deposit to prevent their free expansion.

In Neale, (Table, p. 439, and Table III., Case 141,) a communication existed between an abscess in the axilla and a dilated bronchial tube and small tuberculous cavities in the upper lobe of the left lung, through a carious opening in the second rib. The lower lobe contained many tubercles, but was chiefly solidified by the pressure of strong tendinous pleuritic adhesions. In Boot, (Table, p. 439, and Table III., Case 150,) there were cavities in the upper lobes of both lungs, but that of the right lung was chiefly affected, and the tendinous thickened costal pleura restrained the expansion of, and solidified, the lower lobe.

Those cases of phthisis affecting the whole of one lung are so nearly allied in the physical condition of the diseased part, and in the phenomena of respiratory motion, to the cases of condensed lung from pleural adhesions just considered, that it will be well to examine such cases before those where only the upper portion of the lung is diseased.

CASES OF PHTHISIS IN WHICH THE WHOLE LUNG IS AFFECTED.

In this figure the lungs are not inflated; it represents tranquil respiration. Tubercles and a cavity in the upper lobe of the right lung; tubercles through the right lower lobe; and universally thickened tendinous pleura, prevent the expansion of the whole right lung.

A small cavity on the summit of the left lung: this does not prevent the expansion of that lung, which is free and universal. See pp. 438-443, and Table III., Case 150.

There is, in such cases, general lessening of the most affected and general enlargement of the least affected side; the least affected lung descends considerably, and, in most cases, finds its way beyond the margin of the sternum over to the affected side.

In this figure the lungs are fully inflated: it represents a deep inspiration. In the cases of Neale, (Table III., Case 141,) and Boot, (Table III., Case 150,), the expansion of the lower lobe was restrained, not by the tuberculous deposit so much as by the firm, strong adhesions. Those adhesions formed continuous bands of strong, thick tendons, passing from rib to rib, and enveloping the whole surface of the lung in contact with the costal pleura: they were truly intercostal adhesions. M. Louis (Dr. Walshe's translation, p. 35) found that out of 112 subjects who died of phthisis, one only was entirely free from adhesions; in twenty-five the adhesions were cellular, easily torn, limited; in the rest, they were either extensive or general, composed,