. Physical diagnosis . rarely shows fluid. Interlobar Empyema. In recent years the frequency and importance of empyema lim-ited to an interlobar fissure has become impressed upon many 11 have purposely made but little of the changes in the shape of the chest producedby pleuritic effusions, as it has seemed to me that by far too much stress has usually beenlaid upon such signs. DISEASES AFFECTING THE PLEURAL CAVITY 325 clinicians. I have seen both the post-pneumonic and the tuberculoustypes, but the former is much the commoner. In most of the casesso far reported the pus has been demonstrated i
. Physical diagnosis . rarely shows fluid. Interlobar Empyema. In recent years the frequency and importance of empyema lim-ited to an interlobar fissure has become impressed upon many 11 have purposely made but little of the changes in the shape of the chest producedby pleuritic effusions, as it has seemed to me that by far too much stress has usually beenlaid upon such signs. DISEASES AFFECTING THE PLEURAL CAVITY 325 clinicians. I have seen both the post-pneumonic and the tuberculoustypes, but the former is much the commoner. In most of the casesso far reported the pus has been demonstrated in the fissure whichruns along the vertebral border of the scapula when that bone ispulled as far forward as possible by crossing the arms in front(see Fig. 199). This is a region seldom carefully examined. In the strip here indicated one finds flatness on percussion with(usually) diminished fremitus, and feeble or absent breath-sounds. Compressed areas oflung, showing in-tense tubularbreathing andwhisper with or absent or absent voice. XtAA1 ^yFig. 199.—Signs in Interlobar Empyema. X-ray examination may bring out in sharp relief a shadow corres-ponding to this area and sharply contrasted with the relativelynormal lung above and below it. The exploring needle often fails to find the pus, but the searchshould not be given up (if the physical signs are clear) until a rib hasbeen excised and the region thoroughly explored under completeanaesthesia. Empyema encysted between the diaphragm and lung orbetween the lung and chest wall are not uncommon but can rarely bediagnosed. (c) Pleural Thickening. In persons who have previously suffered from pleurisy witheffusion, and in many who have never to their knowledge had anysuch trouble, a considerable thickening of the pleural membrane withadhesion of the costal and visceral layers may be manifested by thefollowing signs: 326 PHYSICAL DIAGNOSIS (i) Dulness on percussion, sometimes sligh
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