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CHAP. XVII. Of a fracture of the Shoulder, or Arme-bone.
THe Arme-bone is round, hollow, full of marrow, rising up with an indif∣ferent * 1.1 necke, and ending on the upper part into somewhat a thick head. On the lower part it hath two processes, the one before, the other be∣hinde: between which there is (as it were) an halfe circle, or the cavity of a pulley, each end whereof leads into its cavitie, of which one is interior, ano∣ther exterior; that by these (as it were) hollow stops, the bending and extension of the arme might bee limited: lest that the bone of the cubite, if the circle should have beene perfect, sliding equally this way and that way, might, by its turning, have gone quite round, as a rope runnes in a pulley; which thing would much have confused the motion of the Cubite. For so the extension, or bending it backe, would have beene equall to the necessarie bending it inwards. It is very expedient that a Surgeon know these things, that so hee may the better know how to restore the fractures and luxations of this part. If one of the fragments of this broken * 1.2 bone shall lye much over the other, and the patient have a good strong bodie, then the arme shall be much extended, the Patient being so set upon a lowe seat, that he may not rise, when the fracture shall bee a-setting, and so hinder the begunne worke; and also, that so the Surgeon may the more easily performe his operation upon the Patient seated under him: yet Hippocrates, regarding another thing, would have the Patient to sit higher. But you must have a care, that the shoulder-bone it selfe be drawne directly down-wards, and the cubit so bended as when you put it into a scarfe. For if any one set this bone, lifting the arme upwards, or other-wise extending it, then must it be kept in that posture: for otherwise, if the figure be changed, the setting will quickly bee spoyled, when as you come to put the arme in a scarfe. Wherefore the Surgeon must diligently and carefully observe, * 1.3 that in setting a broken arme, hee put it in such a posture, that resting on the breast, it looke downe towards the girdle. You must have a care in laying the splints, and rowling your ligatures, that they hurt not, nor presse too hard upon the joynts. For, in the opinion of Hippocrates, by the pressure of parts which are nervous, * 1.4 fleshlesse, and consequently endued with exquisite sense, by the splints there is danger of most grievous paine, inflammation, denudation both of the bone and nerve; but chiefly, if such compression hurt the inner part, towards which the arme is bended: wherefore the splints made for this place must bee the shorter. There∣fore, after the Arme-bone is set, the arme shall bee layd upon the breast in a right angle, and there bound up in a scarfe, lest that the Patient, when he hath neede to stirre, spoyle and undoe the setting, and figure of the broken bone. But the arme * 1.5 must be kept in quiet, untill such time as the fragments shall bee confirmed with a Callus, which usually is in fortie dayes, sooner or later, according to the different constitutions of bodies.