The lung, when free, is placed upon the board with its hilus downward
and base toward the prosector. (See Fig. 42.) It is then held in the
left hand, as shown in the illustration, the thumb holding the lower
lobe, the index-finger between the lobes with its tip upon the main
bronchus, the other fingers holding the upper lobe. With the long
section-knife held slightly obliquely toward the anterior edge the
main-incision is now made in one sweeping cut from apex to base,
along the line of greatest convexity, down upon the main-bronchus
and its chief branches and the large vessels. Care should be taken
not to cut off the bronchi of the two lobes from the main bronchus.
Incisions parallel to the main one may be made, if desired. Usually
it suffices to go carefully over the remaining part of the lung,
feeling it carefully for airless solid areas; if such are present
they may be sectioned separately. The =bronchi= are then opened from
the cut surface by means of the probe-pointed scissors, cutting as
near to the pleura as possible. The sound or director may be used
with advantage in opening up cavities from the bronchi. The position
of the lung should be so changed that the bronchi always extend
away from the prosector in a straight line. The portion of the lung
containing the uncut bronchus should be left hanging over the left
hand to put it on the stretch, thereby facilitating greatly the
opening of the bronchus. The =pulmonary vessels= are opened with
fine probe-pointed scissors from the cut surface. The bronchial
lymphglands are then sectioned with the knife.
[Illustration: FIG. 43.—Section of right lung. (After Nauwerck.)]
The =right lung= is then lifted up out of the thorax onto the
right side of the thoracic opening, and is either sectioned in
this position, or the mediastinal pleura, pulmonary vessels and
bronchus are cut from below upward with the knife, its edge being
directed against the ribs. When freed the lung is placed on the
board, root downward and apex toward the prosector. (See Fig.
43.) The index-finger is put between the upper and lower lobes,
the thumb holds the upper lobe, the other fingers are spread out
over the surface of the lower lobe. The main-incision is then made
in a sweeping cut, from base to apex, along the line of greatest
convexity, the knife-blade being held slightly obliquely toward the
anterior border (see Fig. 43), cutting down upon the main bronchus
and its first division. Other parallel cuts may be made. The middle
lobe is then sectioned by a sagittal incision on its anterior
surface, directed toward its anterior border. The =bronchi, pulmonary
vessels= and =bronchial lymphnodes= are then opened as in the case of
the left lung.
Bacteriologic examinations may be made from smears or cultures made
from the cut surfaces; or, to avoid contamination, the surface
may be seared with a hot iron and the material obtained by means
of a sterile pipette pushed through the seared surface into the
lung-tissue.
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