PNEUMONIA. 313 



the opposite shoulder and applied to the spine of the scapula of 

 that side, the other scapula becomes so tilted that its vertebral 

 border practically corresponds in position with the great fissure of 

 the lung. 



The transverse fissure of the right lung, which separates the 

 middle from the upper lobe, extends from the middle point of the 

 great fissure to the vicinity of the fourth costal cartilage near the 

 sternum. 



At the back of the chest, the upper and lower lobes of the 

 lungs can be examined. In the axilla, the upper, middle and 

 lower lobes of the right side are accessible, and the upper and 

 lower lobes of the left. In front, on the right side, the upper, 

 middle and very small part of the lower lobes are superficial ; on 

 the left the upper and middle lobes. 



Just internal to the lower part of the vertebral border of the 

 scapula is a thinly covered portion of the chest wall. This area 

 is sometimes known as the triangle of auscultation, and lies over 

 the middle part of the lower lobe of the lung. Its boundaries 

 are the outer border of the trapezius, the lower border of the 

 rhomboideus major, and the upper border of the latissimus dorsi, 

 just before that muscle crosses the angle of the scapula. Over 

 this triangle the breath sounds are very distinct, and lung 

 resonance is easily obtained. 



High in the axilla, over an area corresponding to the first and 

 second intercostal spaces, the upper lobe of the lung is very 

 thinly covered, and the physical signs of apical pneumonia are 

 often first discovered in this situation. 



Pneumonia does not always involve a complete lobe, and so 

 the outlines of the diseased area may not sharply correspond 

 with the fissures of the lung ; it is not uncommon to find a lower 

 lobe completely consolidated and the lobes adjacent only partly 

 invaded. Pneumonia, too, renders the affected lobe more bulky, 

 and often induces partial collapse of the lobe immediately 

 adjacent, this must be borne in mind in attempting to 

 accurately localise the mischief. The visceral layer of the 

 pleura nearly always shares in the inflammation, and, since the 



