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Updated: May 1, 2025
Marks reports the case of a stab-wound penetrating the left 9th intercostal space, the diaphragm, pleura, pericardium, and apex of the heart. It was necessary to enlarge the wound, and, under an anesthetic, after removing one and one-half inches of the 9th and 10th ribs, the wound was thoroughly packed with iodoform gauze and in twenty-one days the patient recovered.
In addition to this muscular action, the upper ribs are also lifted and forced outward by the intercostal muscles, which increases the capacity of the upper chest to its fullest extent.
Illustrative of the degree of hemorrhage which may follow an injury so slight as that of falling on a needle we cite an instance, reported by a French authority, of a child who picked up a needle, and, while running with it to its mother, stumbled and fell, the needle penetrating the 4th intercostal space, the broadened end of it remaining outside of the wound.
When the injury is in the dorsal region, there is paralysis of the legs and of the sphincters of the bladder and rectum, but power is retained in the arms and the upper intercostal muscles act, the extent of paralysis depending on the level of the lesion. In injuries to the lumbar region the legs may be partly paralysed, and the rectal and bladder sphincters may be involved.
At this time discussion will be limited to pain which is not true angina pectoris, but which is in the region of the heart or is referred to it. Intercostal neuralgia is more likely to occur on the left side of the chest than on the right. This is particularly unfortunate, as tending to cause these pains to be referred to the heart.
Mastin reports the case of a man of thirty-two who was shot by a 38-caliber Winchester, from an ambush, at a distance of 110 yards. The ball entered near the chest posteriorly on the left side just below and to the outer angle of the scapula, passed between the 7th and 8th ribs, and made its exit from the intercostal space of the 4th and 5th ribs, 2 1/4 inches from the nipple.
In the rib-action, above alluded to, the lower ribs are controlled by the diaphragm which draws them slightly downward, while other muscles hold them in place and the intercostal muscles force them outward, which combined action increases the mid-chest cavity to its maximum.
I desired Timothy to run for surgical aid as fast as he could, while I opened a vein; and in a few minutes he returned with our opponent, Mr Ebenezer Pleggit. We stripped Mr Cophagus, and proceeded to examine him. "Bad case this very bad case indeed, Mr Newland dislocation of the os humeri severe contusion on the os frontis and I'm very much afraid there is some intercostal injury.
The circulation is, in such a case, maintained through other channels, such as branches from the superior intercostal arteries which enter the anterior spinal artery. While total anæmia of the brain instantaneously abolishes consciousness, partial anæmia is found to raise the excitability of the cortex cerebri.
The front upright corresponds to the breastbone, the back one to the spinal column, the connecting strips to the ribs, and the threads to the intercostal muscles. By slightly raising and spreading apart the ribs the thoracic space is increased in two directions—from front to back and from side to side.
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