319 



coverino- the loins with a thick coat of agglutinative mixture, Avatch 

 and wait for developments. 



Fracture of ilie ribs. — The different regions of the chest are not 

 equally exposed to the violence to which fractures of the ribs are due, 

 and they are therefore either more common or more easily discovered, 

 during life, at some points than at others. The more exposed regions 

 are the middle and the posterior,*while the front is largely covered and 

 defended by the shoulder. A single rib may be the seat of fracture, 

 or a number maybe involved, and there maybe injuries on both sides 

 of the chest at the same time. It may take place lengthwise, in any 

 part of the bone, though the middle, being the most exposed, is the 

 most freciuentl}' hurt. Incomplete fractures are usually lengthwise, 

 involving a portion only of the thickness or one or other of the sur- 

 faces. The comiDlete kind ma}" be either transverse or oblique, and 

 are most commonly denticulated. The fracture may be comminuted, 

 and a single bone may show one of the comj)lete and one of the 

 incomplete kind at different points. The extent of surface presented 

 b}' thethoracic region, with its complete exposure at all points, ex- 

 plains the liability of the ribs to suffer from all the forms of external 

 violence. 



In many instances fractures of these bones continue undiscovered, 

 especiallj' the incomplete variety, without disj)lacement, though the 

 evidences of local iiain, a certain amount of swelling, and a degree of 

 disturbance of the respiration, if noticed during the examination of a 

 patient, may suggest a suspicion of their existence. Abnormal mo- 

 bilitj' and crepitation are difficult of detection, even when present, 

 and they are not always presant. When there is displacement the 

 deformity which it occasions will betray the fact, and when such an 

 injur}' exists the surgeon will of course become vigilant in viev^' of 

 l^ossible and probable complications of thoracic trouble, and prepare 

 himself for an encounter with a case of traumatic pleuritis or pneu- 

 monia. Fatal injuries of the heart are recorded. Subcutaneous 

 emphysema, is a common accompaniment of broken ribs, and we recall 

 the death from this cause of a patient of our own, which had suffered 

 a fracture of two ribs in the region of the withers under the cartilages 

 of the shoulder, and of which the diagnosis vras only made after the 

 fatal ending of the case. 



These hurts are not often of a very serious character, though the 

 union is never as solid and complete as in other fractures, the callus 

 being usually imperfect and of a fibrous character, with an amphiar- 

 throsis formation. Still, complications occur which may impart gravity 

 to the prognosis. 



Fractures with but a slight or no displacement need no reduction. 

 All that is necessary is a simple application of a blistering nature as 

 a preventive of inflammation or for its subjugation when present, 

 and in order to excite an exudation which will tend to aid in the 



