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

CHAP. IX. Of the fracture of the shoulder-blade.

THe Greeks call that Omoplata, which the Latines terme Scapula, or Scapu∣lae * 1.1 patella, that is, the shoulder-blade. It is fastened on the backe to the ribs, nowle, the Vertebrae of the chest and necke; but not by articulation, but only by the interposition of muscles, of which wee have spoken in our Anatomie. But on the forepart it is articulated after the manner of other bones with the collar-bone, the shoulder, or arme-bone: for with its processe, which re∣presents a pricke or thorne, and by some, for that it is more long and prominent, is called Acromion, (that is, as you would say, the top or spire of the said shoulder-blade) it receives the Collar-bone. Therefore some Anatomists, according to Hip∣pocrates as they suppose, call all this articulation of the Collar-bone with the hollowed processe of the shoulder-blade, Acromion. There is another processe of the said Blade-bone, called Cervix om••platae, or the necke of the Shoulder-blade: this truely is very short, but ending in a broad and sinuated head, provided for the receiving of the Shoulder or arme-bone. Not farre from this processe is another, called Coracoides, for that the end thereof is crooked like a Crowes beake. This keeps the shoulder bone in its place, and conduces to the strength of that part. The shoulder-blade may be fractured in any part thereof, that is, eyther on the ridge, * 1.2 which runnes like a hill, alongst the midst thereof, for its safety, as wee see in the Vertebrae of the backe. So also in the broader part thereof it may bee thrust in and

deprest; and also in that articulation, whereby the top of the shoulder is knit to it. According to this variety of these fractured parts, the happening accidents are more grievous or gentle.

Wee know the spine or ridge of the Shoulder-blade to be broken, when a dolo∣rificke inequalitie is perceived by touching or feeling it. But you may know, that the broader or thinner part thereof is depressed, if you feele a cavity, and a prick∣ing paine molest the part, and if a numnesse trouble the arme, being stretched forth. The fragments, if they yet sticke to their bone, and doe not pricke the flesh, * 1.3 must be restored to their state and place, and there kept with agglutinative medi∣cines, and such as generate a Callus, as also with boulsters and rowlers fitted to the place. But if they doe not adhere to the bone, or pricke the flesh lying under them, then must you make incision in the flesh over against them, that so you may take them out with your Crowes beake. But although they stirre up and downe, yet if they still adhere to the periostium and ligaments, (if so be that they trouble not the muscles by pricking them) then must they not bee taken forth: for I have oftner than once observed, that they have within some short time after growne to the ad∣jacent bones. But if they, being wholly separated, doe not so much as adhere to the periostium, then must they necessarily be plucked away; otherwise within some short space after, they will be driven forth by the strength of nature, for that they participate not any more in life with the whole. For that which is quicke, saith Hippocrates, uses to expell that which is dead farre from it. The truth whereof was * 1.4 manifested in the Marques of Villars, who at the battell of Dreux was wounded in his shoulder with a pistoll bullet, certaine splinters of the broken bone were plucked forth with the peeces of his harnesse, and of the leaden bullet; and within some short space after, the wound was cicatrized, and fully and perfectly healed. But more than seven yeares after, a defluxion and inflammation arising in that place by reason of his labour in armes, and the heavinesse of his armour at the battell of Mont-contour, the wound broke open againe; so that many shivers of the bone, * 1.5 with the residue of the leaden bullet, came forth of themselves. But if the fracture shall happen in the necke of the shoulder blade or dearticulation of the shoulder, there is scarce any hope of recovery; as I have observed in Anthony of Burbon, King of Navarre; Francis of Lorraine, Duke of Guise; the Count Rhingrave Phi∣libert, and many other in these late civill warrs. For there are many large vessels a∣bout this dearticulation, to wit, the axillary veine and arterie, the nerves arising from the Vertebrae of the necke, which are thence disseminated into all the muscles of the arme. Besides, also inflammation and putrefaction arising there are easily communicated by reason of their neighbour-hood to the heart and other princi∣pall parts, whence grievous symptomes, and oft times death it selfe, ensues.

Notes

• * 1.1

  An anatomicall description of the shoulder-blade.
• * 1.2

  How many waies the shoul∣der-blade may be broken.
• * 1.3

  The cure.
• * 1.4

  Lib. de vuln. Capitis. A historie.
• * 1.5

  Nature of its owne accord makes it selfe way to cast forth strange bodies and matters. Why a fracture in the joynt of the shoulder is deadly.