After the first costal cartilages have been cut on both sides, the sternum is lifted nearly perpendicularly and twisted slightly toward the right so that the capsule of the left sternoclavicular articulation can be put upon a stretch. The latter is then opened from below until the joint is exposed. With the sternum still pulled firmly upward and toward the right the left sternoclavicular articulation is completely severed, the left sternocleidomastoid and other muscles and fascia attached to the sternum are cut from left to right; and the sternum, twisted over to the right, is disarticulated in the same manner from the right clavicle, and the right sternocleidomastoid cut. The freed sternum is now examined. It may be cut through in the median line with the saw, or cuts made into it with knife or chisel. [Illustration: FIG. 37.—Method of disarticulating sternoclavicular articulation and cutting cartilage of first rib from above. (After Nauwerck.)] Ossification of the cartilages of the ribs is very common in late middle life and old age, more rarely in younger persons. The first cartilages, particularly the left one, and the lower ones usually show it in the most marked degree. It may be impossible to cut them with a knife, and the hand-saw must be used. Ankylosis of the sternoclavicular articulation is also not rare, and it is sometimes necessary to saw through the clavicles. The sternoclavicular articulation and the cartilage of first rib may also be opened from above downward with a long, narrow-bladed scalpel, the incision following the articular surfaces. Many prosectors prefer this method. (See Fig. 37.) The location of the joint and the direction of the incision may be ascertained by moving the arm and shoulder of the cadaver. The sternocleidomastoids may be cut when the skin-flaps are stripped off. In case bacteriologic examination is to be made of the contents of the pleural cavity the incisions into the cavity should be made with a sterilized knife, or the material for culture may be obtained by means of a pipette introduced through a seared interspace. 2. POINTS TO BE NOTED IN THE MAIN INCISION. 1. =Panniculus.= Note thickness at different points in the incision, color (straw-color, rosy or almost white in early life, orange or reddish-yellow in atrophy or old age, brown in severe anæmias), moisture (œdema, serous or purulent inflammation, transfusion; the latter should not be mistaken for pathologic œdema), dryness in atrophy, long-continued fevers, cachexias, etc., number of bleeding points (passive congestion, hypostasis), hemorrhages (recent, old, pigmented).