The occurrence in three patients of fractured ribs following a cough, and the fact that none had been recognized by good clinicians, prompt the recording of these cases.
REPORT OF CASESCase 1.\p=m-\Fractureof fourth and fifth left ribs. Mr. B., aged 34, with extensive pulmonary tuberculosis, was attacked with a very sharp pain in the left side following a severe nocturnal cough. The diagnosis of pleurisy was made. The side was strapped without relief. Finally, morphin had to be administered to control the pain and cough. The left lung having active disease throughout, artificial pneumothorax was attempted, but failed. As the disease was progressing, surgical collapse was decided on, and an operation was performed three weeks after the onset of the severe pain, which had persisted. To the surprise of the surgeon, two ribs, the fourth and fifth, between the internal border of the scapula and the spine, were found completely broken through, with little attempt at healing.Case 2.\p=m-\Fractureof sixth right rib. Mr. K., aged 52, with an advanced condition of pulmonary tuberculosis in the right lung with cavity formation, during a spell of wet weather, while sitting in a rocking chair, coughed violently, and had a sudden severe pain located chiefly in the upper right abdominal quadrant. A diagnosis of diaphragmatic pleurisy was made. The patient was strapped, but this gave little relief because of the severity of the pain, and the fact that it was intensely aggravated by coughing. Morphin was administered. About a week later, after his arrival in Colorado, the patient was seen by us, 'and the diagnosis of fractured rib was suggested. The patient was quite obese, but by careful examination, a definite ridge across the sixth right rib, just below the angle of the scapula, could be made out. Occasionally a slipping motion, which the patient also would feel, could be detected. The pain lasted several months, and was always conspicuous over the upper abdomen on the right side. Very little pain was ever felt at the site of fracture, but discomfort was elicited on deep pressure. A roentgenray examination confirmed the diagnosis.Case 3.-Fracture of ninth left rib. Mrs. K., aged 58, who had pulmonary tuberculosis thirty years ago, now completely arrested, with no signs of activity for many years, and who was very susceptible to attacks of acute bronchitis, during a recent visit to New York contracted bronchitis. The cough was very severe and in paroxysms. Pain developed below the right costal margin, and the patient was treated for pleurisy. Two days later, severe pains developed in the lower axilla on the left side. The patient was then strapped for pleurisy, but with no relief. The distressing cough was controlled by opiates. On her return to Colorado Springs, the patient was still coughing and suffering severely. A diagnosis of fracture of the ninth rib on the left side in the midaxillary line was made. A definite ridge could be felt across the rib, and the patient was very sensitive over this spot. There was no pain at the...
