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THE problem to be faced by the surgeon in attempting to secure by operative means the obliteration of the cavity of a chronic empyema may be attacked from two different directions, according to his decision to deal either with the lung or with the chest wall. On the inner side of the cavity is the lung, collapsed to a greater or lesser extent; and on the outer side is the chest wall in the condition assumed in expiration, the degree of retraction depending on the size of the cavity. The tension in a large unopened empyema seriously compresses the lung, but if the thickening of the visceral pleura, as a result of the inflammation, be not very excessive, ordinary, and more especially forced, expiratory movements after the fluid has been evacuated will successfully re-expand the lung and bring it once more in contact with the chest wall. It is impossible to estimate the loss of elasticity in a shrunken lung, depending on interstitial fibrosis in its substance, that may have occurred as the result of a chronie empyema. It is to be expected that these interstitial changes will be greater after a purulent than after a serous pleural effusion, and Dr. West has recently recorded 2 cases of serous effusion of eighteen months' and twelve months' duration respectively, in which re-expansion occurred with greats readiness upon the fluid being let out. This does not often happen in cases of empyemata of long duration, but the same observer has placed on record a case of an unopened empyema which had been present for six months, and in which reexpansion occurred rapidly when the pus was evacuated. In the case of a chronic empyema of ordinary type, the chest wall on the outer side of the cavity is depressed to a certain extent, but not sufficiently so to reach the lung and cause obliteration of the cavity. The thoracic wall on this side moves very little in respiration as compared with that of the opposite side. There is no useful purpose to be served int its expanding: it cannot draw the luDg with it. Automatically and without the knowledge of the patient, the respiratory mechanism has accommodated itself to the altered circum-

Seven Cases of Thoracoplasty Performed for the Relief of Chronic Empyema