THE LUNGS 



1367 



The lymphatics have ahead}^ been described (p. 721, fig. 566). 



In removal of the breast elliptical incisions will usually suffice if employed on wide lines, 

 and if attention be paid to the following points: — (1) Those details in the surgical anatomy 

 already referred to, especially those bearing on the extensiveness of this organ, and the propor- 

 tionate difference between seen and unseen disease. (2) The importance of removing in one 

 continuous piece the whole breast, all the skin over it, the costo-sternal part of the pectoralis 

 major, the pectorahs minor, the axillary fat, and lymphatics. 



Outline of the lungs. Their relation to the chest-wall. — To map out the 

 lung, a line should be drawn from the apex, a point about 2.5 cm. (1 in.) above the 

 clavicle, a little lateral to the sterno-mastoid muscle, at the junction of medial 

 and middle thirds of clavicle, obliquely downward, behind the sterno-clavicular 

 joint, to near the centre of the junction of the first and second bones of the ster- 

 num. Thence, on each side, a line should be drawn slightly convex as far as a 

 similar point on the sternum lying opposite the articulation of the fourth chondro- 

 sternal joint. On the right side the line may be dropped as low as the sixth chon- 

 dro-sternal joint; on the left the incisura cardiaca may be shown by drawing a 

 vertical line along the middle line of the sternum, from the level of the medial 

 extremities of the fourth costal cartilages to the lower end of the gladiolus, and 



Fig. 1107. — Outline of the Heart, its Valves, the Lungs (shaded), and 'the Pleura. 



(Holden.) (Cf. fig. 437.) 



by carrying two other lines, from the extremities of the first line, outward so as 

 to meet at a point over the heart's apex (Cunningham); to mark this gap, a 

 line should be drawn sloping laterally and downward from the fourth chondro- 

 sternal articulation across the fourth and fifth interspaces, to a point about 

 3.7 cm. (1| in.) below the left nipple (male) and 2.5 cm. (1 in.) to its medial side. 

 This point, lying in the fifth space, marks the apex of the heart. Thence the line 

 curves medially to the sixth costal cartilage, a little medial to its chondro- 

 sternal junction, and in the lateral vertical line. Thus the lower part of the 

 anterior surface of the right ventricle is not covered by lung. The lower border 

 of the lung will be marked on the right side by a line drawn from the sixth chondro- 

 sternal articulation across the side of the chest down to the tenth thoracic spine. 

 The lower border of the left lung will follow a similar line, starting on a level 

 with a similar joint (sixth chondro-sternal joint), but much farther laterally 

 than on the right side, i. e., in the fifth space, about 7.5 cm. (3 in.) to the left 

 of the middle line, or a point corresponding to the heart's apex. In the nipple- 

 line the lung crosses the sixth rib, in the mid-axillary line the eighth, and opposite 



