218 
FRACTURES OF THE RIBS. 
what it does carry are deposited on the surface of the respiratory mucous 
membrane. Hence, both in man and animals, unexpectedly good results 
not infrequently occur, especially where the skin is not perforated. A 
further danger occurs from pleurisy and pneumonia, or from injury to 
thoracic blood-vessels (arterise intercostales et thoracicae internae), 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 com¬ 
plications 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 evi¬ 
dence 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 disturbance in the movement of the forelimb and 
greater difficulty in breathing, because of the attachment of the muscles 
of the limb, and those of respiration of this point. Rogers, Yennerholm, 
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,” p. 857. Frick, 
in a dog with fracture of the left first rib, noted paralysis of the left 
recurrent nerve, hoarseness, a symmetry of the vocal cords, and altera¬ 
tion in the voice. Recovery occurred in six weeks. When the skin is 
perforated the broken fragments can often be directly seen. Dogs with 
multiple fractures of the ribs usually show more pronounced disturbance, 
