THE METHOD OF MAKING POST-MOKTEM EXAMINATIONS. 25 



given above. After the commencement of putrefaction reddish serum 

 may accumulate in the pleural cavities. This should not be mistaken 

 for the result of disease. 



The Lungs. Each lung is lifted up in turn, the vessels, etc. , at its base 

 are divided, and the organ is removed. If the pleura is very adherent it 

 is better to strip off the costal pleura with the lung. After inspecting 

 the external surface of the lung, observing its size, shape, color, and con- 

 sistence, and the condition of the bronchial lymph nodes, the bronchi 

 are opened with scissors having long, narrow, blunt-pointed blades, one 

 blade a little longer than the other. The lung is held in the left hand 

 with its base upward, the large bronchi which run on the inner side of 

 the lower lobe being first opened, afterward those of the upper lobe. 

 Each bronchus should be followed to its smaller ramifications. 



\W should observe the contents of the bronchi and the appearance of 

 their walls. In the larger and medium-size bronchi the cartilages in 

 their walls do not form complete rings, but appear shining through the 

 mucous membrane like irregular white patches. This appearance should 

 not be mistaken for a pathological change. In bodies which have been 

 dead for some time, especially in cold weather, the bronchial mucous 

 membrane may be red and swollen as a post-mortem change. The 

 contents of the stomach are sometimes forced, after death, into the 

 pharynx, and thence find their way into the trachea and bronchi, giving 

 them a peculiar reddish and even gangrenous appearance. Bronchitis 

 does not always leave lesions which can be seen after death. The large 

 vessels should now be examined for thrombi, emboli, or other lesions. 



After the examination of the bronchi the lung is turned over, the 

 vessels, etc. , at its root are grasped with the left hand, and a long, deep in- 

 cision is made from apex to base. We observe the appearance and texture 

 of the lungs, whether the air vesicles are dilated (emphysematous) or 

 filled with serum, blood, or inflammatory exudation. Fluid can be 

 pressed out of the air vesicles without breaking down the lung tissue. 

 Solid inflammatory exudation, on the other hand, renders the lung more 

 resistant and easily broken down. Attention should be paid to the ooz- 

 ing of purulent or other fluid from the smaller bronchi when the lung 

 is squeezed near the cut surface. It is the rule to find the lower lobes 

 more congested than the upper. 



PRESERVATION OF THE LUNGS AND BRONCHI. If the lungs have been cut, small 

 pieces from the affected portions of lung tissue or bronchi should be hardened in Orth's 

 fluid, care being taken not to squeeze or handle them unnecessarily. It is better, when 

 the microscopical examination is more important than the macroscopical, not to open the 

 lungs at once, but to fill the air spaces with preservative fluid by means of a funnel 

 attached to a short rubber tube and canula, which is tied into the main bronchus. In 

 this way not only are the minute structures better preserved, but the air vesicles are 

 filled out and hardened in an approximately natural condition. Care should be taken 

 not to have too great a pressure from the inflowing fluid, since then exudations might 

 be displaced or the lung distorted or ruptured. While the lung is being filled it should 

 be immersed in a vessel of the same preservative fluid, in which, after closing the can- 

 ula or ligating the bronchus, it lies for twenty-four hours. It is then cut into small 

 pieces and the hardening completed. A variety of hardening agents may be used: 



