ere may be 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 frequently hurt.
Incomplete fractures are usually lengthwise, involving a portion only of
the thickness of one or other of the surfaces. The complete kind may be
either transverse or oblique, and are most commonly denticulated. The
fracture may be comminuted, and a single bone may show one of the
complete and one of the incomplete kind at different points. The extent
of surface presented by the thoracic region, with its complete exposure
at all points, explains the liability of the ribs to suffer from all the
forms of external violence.

_Symptoms._--In many instances fractures, especially the incomplete
variety, of these bones continue undiscovered, without displacement,
though the evidences of local pain, 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 mobility and crepitation are difficult of detection, even when
present, and they are not always present. When there is displacement the
deformity which it occasions will betray the fact, and when such an
injury exists the surgeon, in view of possible and probable
complications of thoracic trouble, of course will become vigilant and
prepare himself for an encounter with a case of traumatic pleuritis or
pneumonia. Fatal injuries of the heart are recorded. Subcutaneous
emphysema is a common accompaniment of broken ribs, and I recall the
death, from this cause, of a patient of my 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 was made only after the
fatal ending of the case.

These hurts are not often of a very serious character, though the union
is never so solid and complete as in other fractures, the callus being
usually imperfect and of a fibrous character, with an amphiarthrosis
formation. Still, complications occur which may impart gravity to the
prognosis.

_Treatment._--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 support and immobilization of the pa