The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. VIII. Of the Fracture of the Clavicle or Collar-bone.

AS the nature and kinde of the fractured Clavicle shall bee, so must the cure and restoring thereof bee performed. But howsoever this bone * 1.1 shall be broken, alwaies the end fastened to the shoulder and shoulder-blade, is lower than that which is joyned to the chest; for that the arme drawes it downe-wards. The collar-bone, if broken athwart, is more easily restored and healed, than if it be cloven long-wayes. For, everie bone bro∣ken athwart doth more easily returne into its former state or seat, whiles you lift it up on this or that side with your fingers. But that which is broken schidacidon, or into splinters, or long-waies, is more difficultly joyned and united to the ends and fragments: for those peeces, which were set, will be plucked asunder, even by the least motion of the armes; and that which was knit with the shoulder, will fall downe to the lower part of the breast. The reason of which is, the Collar-bone is not moved of its selfe, but consents in motion with the arme. In restoring this or * 1.2 any other fracture, you must have a care that the bones ride not one over another, neyther be drawn nor depart too far in sunder: therfore it will be here convenient, that one servant draw the arme backwards, and another pull the shoulder towards him the contrarie way; for so there will be made, as I may so terme it, a counter-extension. While which is in doing, the Surgeon with his fingers shall restore the fracture, pressing downe that which stood up too high, and lifting up that which is pressed downe too low. Some, that they may more easily restore this kinde of * 1.3 fracture, put a clew of yarne under the Patients arme-pit; so to fill up the cavity thereof: then they forcibly presse the elbow to the ribs, and then force the bone into its former seat. But if it happen, that the ends of the broken bones shall bee so * 1.4

deprest, that they cannot be drawn upwards by the forementioned means: then must the Patient be layd with his backe, just betweene the shoulders, upon a pillow hard stuffed, or a tray turned with the bottome upwards, and covered with a rugge or some such thing. Then the servant shall so long presse downe the Patients shoul∣ders with his hands, untill the ends of the bones, lying hid and pressed downe, fly out and shew themselves. Which being done, the Surgeon may easily restore or set the fractured bone. But if the bone be broken so into splinters that it cannot bee re∣stored, and any of the splinters pricke and wound the flesh, and so cause difficultie of breathing, you then must cut the skinne even against them, and with your instru∣ment lift up all the depressed splinters, and cut off their sharp points; so to prevent all deadly accidents, which thereupon may bee feared. If there be many frag∣ments, they, after they are set, shall be covered with a knitting medicine made of wheat floure, frankincense, bole armenicke, sanguis draconis, resina pini, made into powder, and mixed with the whites of egges, putting upon it splints, covered with * 1.5 soft worne linnen raggs; covered over likewise with the same medicine, and then three boulsters dipped in the same; two whereof shall be layd upon the sides, but the third and thickest upon the prominent fracture, so to represse it and hold it in. For thus the fragments shall not be able to stirre or lift themselves up further than they should, eyther to the rightside or left. Now these Boulsters must be of a con∣venient thicknesse and breadth, sufficient to fill up the cavities which are above and below that bone. Then shall you make fit ligation with a rowler, having a double head cast crosse-wise, of a hands breadth, and some two ells and a halfe long, more or less, according to the Patients bodie. Now hee shall be so rowled up, as it may draw his arme somewhat backwards, and in the interim his arme-pits shall be filled with boulsters, especially that next the broken bone; for so the Patient may more easily suffer the binding. Also you shall wish the Patient, that he of himselfe bend his arme backewards, and set his hand upon his hip, as the Countrey Clownes use to doe, when they play at leap-frogge. But how great diligence soever you use * 1.6 in curing this sort of fracture, yet can it scarce be so performed, but that there will some deformity remaine in the part: for that a ligature cannot be rowled about the collar-bone, as it may about a legge or an arme. A Callus oft times growes on this bone, within the space of twenty daies, because it is rare and spongious.

Notes

• * 1.1

  Hipp. sect. 63. sect. 1. de art.
• * 1.2

  How to restore the fractured Clavicle. The first way.
• * 1.3

  The second way.
• * 1.4

  The third way.
• * 1.5

  How to binde up the fractured clavicle.
• * 1.6

  It is a difficult matter perfect∣ly to restore a fractured cla∣vicle.