474 FRACTURES OF THE RIBS. 



in as large amount as was formerly believed. Hence, both in man 

 and animals, unexpectedly good results not infrequently follow. 

 Greater danger arises from pleurisy and pneumonia, or from injury 

 to thoracic blood-vessels (arteriae intercostales et thoracicse interna?), 

 which may lead to fatal haemorrhage ; in this connection fractures 

 of the ribs are especially dangerous, as other large vessels may easily 

 become damaged from this point. In a case in which a runaway 

 horse struck against a tree, broke several ribs, and died in a few 

 minutes, the post-mortem showed not only rupture of the blood- 

 vessels at the anterior opening of the thorax, but injury to the heart 

 by fragments of bone. Collisions with the carriage pole cause similar 

 injuries. 



Kohne treated a horse with complicated fracture of the ribs caused 

 by collision with the pole of a carriage ; though a large wound existed 

 in the skin, both fracture and wound united in two months. Six months 

 later a new swelling appeared, which broke, and discharged freely ; the 

 finger, introduced between the 9th and 10th ribs, discovered a large cavity 

 from which the pus had come. The'animal recovered, but was troubled 

 later with chronic cough. 



Injuries and ruptures of the diaphragm occasionally happen as 

 complications of costal fractures. When broken ribs perforate the 

 abdominal walls, fatal peritonitis is apt to ensue. 



Symptoms. In partial and subcutaneous fractures there may 

 only be somewhat hurried breathing, without further disturbance. 

 Crepitation may sometimes be heard during breathing, and is the 

 most reliable evidence of fracture. When the pleura is injured, there 

 is a tendency to cough, and more rapid respiration : whilst where 

 the lung is involved, the cough may be accompanied by blood-stained 

 discharge from the nose or mouth, and subcutaneous emphysema. 

 Fractures of the first ribs are accompanied by marked loss of power 

 in the forelimb and disturbance in breathing, because of implication 

 of the nerve supply of the muscles of the limb, and those of the thoracic 

 wall. Rogers, Vennerholm, and many later observers have described 

 such cases. Rogers was probably the first to point out that fracture 

 of the first rib is frequently associated with symptoms of radial 

 paralysis. Hunting's view, however, that all cases of " dropped 

 elbow " (the chief symptom of radial paralysis) are due to fractured 

 first rib is evidently too sweeping, and has been corrected by later 

 observations. Rogers' case is reported in Cadiot and Dollar's 

 " Clinical Veterinary Medicine and Surgery." Frick, in a dog with 

 fracture of the left first rib, noted paralysis of the left recurrent 

 nerve, hoarseness, asymmetry of the vocal cords, and alteration 



