314 CLINICAL APPLIED ANATOMY. 



pleural layers of the fissures are in close contact, they are easily 

 agglutinated by pneumonic inflammation. Localised empyemata 

 may form in a fissure thus sealed up. 



Sometimes the pericardium is involved as well as the pleura, 

 but it by no means follows that this is always an invasion from 

 the adjacent lung. In some epidemics mitral and aortic endo- 

 carditis are associated with the lung disease, these are the first 

 valves which come into contact with blood returned from the 

 lungs, and this, together with the occurrence of complications in 

 other parts of the body far distant from the lungs, must be 

 attributed to blood infection. Delirium, meningitis, arthritis, 

 albuminuria, nephritis, enteritis, and peritonitis may be cited as 

 examples of this. 



Obstruction to the circulation in the consolidated lung natur- 

 ally throws a strain upon the right ventricle, which, being at 

 the same time poisoned by the toxaemia, may undergo rapid 

 dilatation. 



Pneumonia being a disease of the alveoli and the contiguous 

 structures the whole of the exudation in the lung may be absorbed 

 and carried away by the lymphatics with which the alveoli are 

 supplied, and none expectorated. This contrasts strongly with 

 what occurs in bronchitis where lymphatics play little or no part 

 in getting rid of the secretion. 



PULMONARY PHTHISIS. 



The channels by which infection may reach the lung, and the 

 methods of dissemination in that organ, have been pointed out in 

 the section on tuberculosis. Attempts to account for the primary 

 localisation of phthisis at the apices on anatomical grounds have 

 not yet produced any convincing explanation. 



In making a diagnosis of apical tuberculosis from physical 

 signs, the normal differences between the signs at the two apices 

 must be borne in mind. The lungs either extend to an equal 

 height above the clavicles or the right is a little higher than the 

 left. The normal outline of the apex passes from the seventh 

 cervical spine outwards and upwards to a point on the anterior 



