THE THORAX. 175 



united by a joint with a single cavity. These joints may be the seat of metastatic 

 abscesses in pyaemic infections. 



Cervical ribs spring from the body and transverse process of the seventh 

 cervical vertebra. They may be long enough to reach to the sternum, but usually 

 are much shorter. One case of this affection was seen by the writer in a man 

 twenty-seven years of age. There was an abnormal fulness above the scapula 

 posteriorly, and above the clavicle anteriorly, just to the inner side of the external 

 jugular vein, a distinct bony process could be felt. This did not move with the 

 scapula or clavicle but did move somewhat with respiration. A skiagraph showed 

 it to be attached to the spine. The patient was seen again five years later, 



FIG. 198. A cervical rib attached to the right side of the seventh cervical vertebra. 



when the same condition of affairs existed, with the exception that movement on 

 respiration was not so marked. A knowledge of the possible presence of a cervical 

 rib is important in diagnosis, otherwise it may be thought to be a bony or malignant 

 new growth and treatment advised accordingly. The subclavian artery may pass 

 over the cervical rib above and may have its circulation seriously interfered with. 



Fracture of the Ribs. The ribs are almost always broken by direct violence; 

 fractures from indirect force, as from coughing, sneezing, and other forms of muscular 

 exertion, are rare. Fracture from compression of the chest is also rare. The site of 

 the fracture is most frequently on the anterior portion of the chest and not the sides 



FIG. 199. Fractured ribs; fusion of callus. 



or back. The fourth, fifth, sixth, and seventh ribs are most often broken. The first 

 rib is well protected from direct blows by the clavicle. Lane, however, has shown 

 that it can be broken by pressure of the clavicle when- the shoulder is depressed. 

 The eleventh and twelfth, being floating ribs, are rarely broken. The twelfth rib is 

 the least frequently so. In one case we saw the eighth, ninth, tenth, eleventh, and 

 twelfth all broken by the passage of a wheel. The soft parts attached to the frag- 

 ments prevent much displacement, but there is always some, due to the respiratory 

 movements. Hence callus is always present and it may be so abundant as to join 

 adjacent ribs (see Fig. 199). As already stated, death frequently follows fracture of 

 the ribs and is due to wounding of the chest contents. Rarely the intercostal arteries 

 may be wounded and produce haemothorax. Wounding of the lung is frequent. 



