Clinical tuberculosis . her. Bronchogenic infection, for the mostpart, follows the same course, but it may, like hematogenic in-fection also go from one lobe to the other, or from one lung tothe other. The divisions between the lobes is shown in Figs. 51, 52, and , the division between the upper and lower lobe may beroughly marked by placing the hand upon the opposite shoulder,which throws the lower point of the scapula out toward theaxilla, and drawing a line along its inner border. This line whenprolonged, as in Fig. 57, page 324, roughly marks the division be-tween the
Clinical tuberculosis . her. Bronchogenic infection, for the mostpart, follows the same course, but it may, like hematogenic in-fection also go from one lobe to the other, or from one lung tothe other. The divisions between the lobes is shown in Figs. 51, 52, and , the division between the upper and lower lobe may beroughly marked by placing the hand upon the opposite shoulder,which throws the lower point of the scapula out toward theaxilla, and drawing a line along its inner border. This line whenprolonged, as in Fig. 57, page 324, roughly marks the division be-tween the ?iSJ. PHYSICAL EXAJIIXATIOX OF ORGANS OF THORAX In advanced tuberculosis the greatest destruction of pulmo-nary tissue usually occurs in the upper lobes, and is followedby contraction. A compensatory emphysema follows in thelower lobe and in the othei lunir, causinci; their enlargement. Inconsequence of these changes there is a shifting of the trachea, inter-lobular septum, mediastiimm, and diaphragm. It is not infre-. LOW£R MARGINOF LUNG --- LOWER IVRCINOF PlEURA- -lower margin Of PlEDRA Fig. 51.—Illustraling the normal borders of the lungs and the location of the interlobularsepti. Anterior view. (Corning.) quent in athanced eases witli marked destructive processes inone upper lobe, to find it contracted to a small tiluous mass andthe lower lobe anteriorly up toward tlie apex. Sucha case is shown in Fig. 40, page 286, where the middle lobe isshown as a fibrous string and the lower lobe pushed upward tothe third rib. In this case the compensation was so great that PERITRACHEAL AND PERIBRONCHIAL GLANDS 323 most of the right side of the chest on the anterior surface as wellas the left was occupied by the left lunsr. The Projection of the Peritracheal and Peribronchial Glandson Body Surface.—The projection of the peritracheal and peri-bronchial glands on the surface becomes of great importance
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