COSTAL SINUS. 
219 
especially if many ribs are broken. The severity of the symptoms 
increases with the number of ribs broken and the degree of displace¬ 
ment. 
Treatment in simple and partial fractures consists in keeping the 
animal quiet, and guarding it against work and movement. Even in 
complicated fractures, with injury of the pleura and lungs, nothing 
further may be necessary. Reduction in such cases is difficult. Hertwig 
recommends placing large animals with the sound side against a tree, 
and endeavouring to bring about reposition by drawing the hind-quarters 
towards this side. If the skin be broken, fragments of bone dislocated 
inwardly may be replaced by pushing a finger or hook under the anterior 
border of the rib, thus avoiding the vessel and nerve which pass down 
the posterior border. Antiseptic precautions should be observed, and a 
dressing afterwards applied to guard the wound against infection. Injury 
of the skin greatly increases danger, and under no circumstances should 
a wound be artificially produced for the object of reposition ; it is much 
better to adopt an expectant treatment. Charpentier and Lafourcade, in 
100 slaughtered swine found 15 with united fracture of the ribs, 10 
without further injury, 5 with adhesion of the lungs, and 8 with pleuritic 
thickening. Cases of one broken rib were rare ; and two or three were 
usually affected. The fracture occurred in the middle of the rib or in 
its lower portion. According to Stockfieth, the first ribs seem especially 
prone to break at their upper end. 
II.—COSTAL SINUS. 
, Chronic inflammatory processes in the thoracic wall, with formation 
of sinuses, are more frequent in horses than in other animals. They 
usually result from necrosis of one or more ribs due to direct injuries or 
to cellulitis, occasionally to burrowing of pus in fistulous withers, or 
formation of strangles or glanders abscesses. When depending on 
necrosis of bone, the sequestrum, if allowed to remain, causes chronic 
inflammation, with pus formation and thickening of the ribs and of 
their surroundings, which may persist for months and even years. The 
condition seldom leads to pleurisy, the fascia endothoracica and pleura 
becoming thickened, and preventing complication. 
The symptoms consist in a swelling more or less extended, seldom 
sharply defined, but hard and firm, without evidence of acute inflamma¬ 
tion. A narrow opening exists in the centre of the swelling, and a probe 
passed through this is arrested by the hard, rough surface of the rib. 
General disturbance is commonly wanting; symptoms of pleurisy only 
occasionally occur, but when they do, almost invariably result in 
death. 
