Page:Cyclopaedia, Chambers - Supplement, Volume 2.djvu/369

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tuberofity; in the fecond, it reaches but to a fmall diftance from it ; in the third ribj this diftance is ftill greater, and from thence it continues to increafe gradually all the way to the third fetfe rib ; fo that if we look directly at the back of a fcele- ton, thefe angles reprefent the legs of a pair of compafles opened pretty wide. On the infide of the ribs,'- toward the lower edge, we obferve a groove reaching all the way from the angle to the extremity, and that chiefly in the five lower true ribs, and the three firft falfe ones. The upper edge o/ the three firft ribs is fharp, the lower a little rounded. The upper edge of the third is more obtufe, and the lower a little more flat. In the reft, the upper edge is rounded, the lower, more or lefs fharp.

In all the ribs the anterior extremity is lower than the pofte- rior j the ribs are much more crooked in the back than in the forepart ; the appendices, epiphyfes, or cartilaginous ■ portions of the true ribs, increafe in length, as they defcend in the fame manner as the ribs themfelves ; the cartilages of the firft three or four ribs -lie nearly in the fame direction with the ribs themfelves. In the ribs below thefe, the car- . tilages make angles, at which they turn upward towards the fternum, and this curvature increafes in proportion as the ribs defcend ; and the loweft cartilages, in changing their direction upwards, lie very clofe to each other, and thofe of the laft two ribs have often, at their inferior edge, a fort of apophyfis or production, by which they are connected with the cartilages immediately below them. The laft two ribs extend confiderably in breadth toward their lower fharp edges, from the angle for a good diffance anteriorly. After- wards they contract in breadth and increafe in thicknefs, forming a fort of neck, a little longer than that at their po- fterior extremity ; then their breadth begins to increafe again, by degrees, to the anterior extremity. In all the ribs, this extremity terminates in a cavity, in which the cartilages are grafted. The three uppcrmoft falfe ribs in- creafe in breadth from the angle forward, and the grooves are raoft confiderable in thefe. They have alfo heads, necks, tuberolities, and angles, almoft the fame as in the laft true ribs. Alt the falfe ribs have cartilaginous appen- dages ; the firfl: of which is longcff, and fixed to the car- tilage of the laft true rib ; the two following are united to- gether at their extremities, and the two laft are connected only to mufcles and ligaments. They are both very fhort, efpecially the laft, which is not above a quarter of an inch in length, and all thefe cartilages of the falfe ribs are pointed at their extremities.

The ribs are articulated anteriorly with the fternum, and behind with the vertebras of the back ; the firft rib is en- tirely united with the fternum, by means of its cartilage, and in the fix following the extremities of the cartilages join that bone. The three upper falfe ribs are joined to each other by the extremities of their cartilages ; the connection of the ribs, with the vertebras of the back, is for the moft part by ginglymus. The ten upper ribs are confined to two motions only, upward and downward ; whereas the two laft are left more at liberty, and are therefore termed float- ing ribs. Win/low's Anatomy, p. 65.

Cartilages of the Kirs. All the ribs have cartilaginous por- tions, which differ from each other in length, breadth, in- curvations, adhefions, and in their extremities. It is to be obferved, that thefe cartilages are white, more po- lifhed, broader and thicker in their natural ftate, than in the dried fceleton. The cartilages of the falfe ribs are na- turally fofter, and more pliable than thofe of the true ; the middle or inner fubftance of thefe acquires the con- fiftence of bones in old age, and their extremities fome times offify, and are immoveably fixed to the fternum. Ibid. p. 149.

Ligaments of the Ribs. All the ribs are connected to the bo- dies of the vertebras by ftrong, fhort, ligamentary fafciculj, fixed by one end round the foflula in the vertebras, and by the other round the head of each rib. They are alfo tied together by thin ligaments, which go from the cartilage of, each rib obliquely to that of the next. The ten uppermoft ribs on each fide are connected to the tranfverfe apophyfes of the vertebras of the back by ftrong, fhort, articular liga- ments fixed to the tuberofities of the ribs, and round the fof- fula of the apophyfes ; and this much in the fame manner with thofe which go between the heads of the ribs and bodies of the vertebra : both thefe articulations are provided with capfular ligaments. The eleventh rib on each fide having no articulation with the tranfverfe apophyfes, is connected to them by auxiliary ftrong fhort ligaments fixed in its neck. The laft rib is only joined by its head to the body of the twelfth vertebra of the back ; but it is connected, in a particular manner, to the tranfverfe apophyfis of the firft vertebra of the loins by a broad ligament, fixed in the whole upper edge of the apophyfis, and in the lower edge of the r 'b, though about two thirds of its length. The firft true fib has iio ligamentary connection with the fternum, the cartilaginous fymphyfis being fufficient; the reft are clofcly joined to that bone by fmall ligamentary portions, fixed by one end round the extremity of the cartilage, and by the other round the notches in the fternum. The cartilage of

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the firft falfe rib Is joined to that of the laft true rib, by feve- ral fhort filaments, which go from the lower edge of the one to the upper edge of the other near its fmall extremity. The other falfe ribs are connected together much in the fame manner ; except that the filaments, by which the fourth is connected to the third, are longer than thofe above them, and thofe between the fifth and fourth are much longer than any of the reft ; and for this reafon thefe ribs are lefs fteady than the others. The ligamentary expanfions of the vertebra are in place of a periofteum, but the ribs and fternum have a periofteum like other bones, only that the cartilaginous portions of the ribs generally give their covering the name of a pericardium.

DiJIocatcd Ribs. The ribs are fometimes, though but fel- dom, diflocated ; for they are fometimes difplaced by fome external violence, and thruft either upwards or downwards, outwards or inwards. They cannot eafily in- deed be luxated outwards, becaufe prevented by the verte- bral procefles, and refifted by very thick and ftrong mufcles ; but when they are driven into the cavity of the thorax, which oftener happens, they not only lacerate the pleura, or membrane, which lines the cavity of the thorax, but gene- rally do great injury alfo to the contained parts : in confe- quence of which arife moft fharp pains, inflammation, dif- ficulty of breathing, coughs, ulcers, immobility, and many other dangerous fymptoms.

When the rib is luxated either upwards or downwards, in order to replace it conveniently, the patient is to be laid on his belly upon a table, and the furgeon muft endeavour to reduce the luxated bone to its right place with his hands ; or the arm of the difordered fide may be fufpended over a gate or ladder ; and while the ribs are thus ftretched up from each other, the heads of fuch as are luxated may be pufhed into their former feat.

Thofe luxations, where the heads of the ribs are found to be thruft inwards into the cavity of the thorax, are much the moft difficult to be reduced, becaufe neither the hand, nor any other inftrument can be applied internally, to affift and direct the bone in the operation. In this cafe it feems pro- per to lay the patient on his belly, over fome gibbous or cy- lindric body, and move the forepart of the rib inwards to- ward the back, fhaking it fometimes ; for thus it fometimes happens, that the head of the luxated rib flips into its former place. But if this method of cure will not avail, we have no remedy left but incifion, and endeavouring to replace the luxated head of the rib by the fingers, plyers, or little hooks. In the mean time, where the fymptoms arc not very urgent, and the heads of the ribs but little difplaced, it is much more advifeable to have recourfe to none of thefe means, becaufe there are feveral inftances where the luxated ribs have fafely retained their diflocated ftations ; but above all, care muft be taken to lay on a comprefs, dipped in warm fpirit of wine upon the part, and retain it on by the napkin and fcapulary bandage. Heijler^ Surg. p. 157.

Fraflured Ribs. Sometimes the ribs are only fiflured in fuch a manner, that the external or internal part of them are only hurt, without their being removed out of their place. This is ufually attended by no bad accident, and the bone fre- quently grows together again of itfelf, without the accident's being difcovered. But if the whole rib be fractured, and fome part of it removed out of its place, it is a more dan- gerous cafe : for the coftal mufcles, and the pleura, that lines the internal cavity of the thorax, will be much dif- turbed by the fragments of the bone.

When a rib is fractured, it projects either externally or in- ternally in the form of a broken arch ; when it projects ex- ternally the fymptoms are ufually much milder ; but when it is drove inward the cafe is ufually much worfe, efpecially if any vein or artery be divided by it, fo as to let blood run into the cavity of the thorax : in confequence of which there follow prickings, inflammation, difficult refpiration, coughs, fevers, fpitting of blood, fuppuration, extravafation of blood, and other bad fymptoms, particularly if any of the vifcera are hurt at the fame time.

In order to replace fractured ribs, it is necefTary firft to .en- quire whether they project internally or externally ; when externally, the patient is to be placed upon a high table, and the feparated bones muft be gently forced by the fin- gers into their places ; the proper comprefTes, dipped in fpirit of wine, muft be laid on, and then covered with flips of pafthoard, or fplints, and the circular bandage, or nap- kin and fcapulary. But when the fplinters are thruft in- ward, while the patient retains a deep breath; both fides of the bone muft be comprefled with the hands, and agitated till they are properly fixed. When they are replaced, the paftboard muft not be applied in this cafe, but only the ban- dage drawn a little lefs tight; by thefe means, fractures of this kind are ufually cured in three or four weeks. Ibid, p. 123.

Ribs of fijhes. There is a very great variety in the fnapc, and other peculiarities of the ribs of fifhes. They are in fome fmooth and flatted fideways, as in the cyprini. In others they are rounded, as in 'the cotti and gadi. In the

cyprini