CHAP. IX. Of the fracture of the Shoulder-blade.
* 1.1THe Greeks call that Omoplata, which the Latines tearm Scapula, or Scapulae patella, that is, the shoulder-blade. It is fastned on the back to the ribs, nowle, the Vertebrae of the chest and neck; but not by articulation, but only by the interposition of muscles, of which we have spoken in our Anatomy: But on the forepart it is articulated after the manner of other bones, with the collar-bone, the shoulder, or arm-bone: for with its process, which represents a prick or thorn, 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. There∣fore some Anatomists, according to Hippocrates, as they suppose, call all this articulation of the collar-bone with the hollowed process of the shoulder-blade, Acromion. There is another pro∣cess of the said Blade-bone, called Cervix omoplatae, or the neck of the shoulder-blade; this truely is very short, but ending in a broad insinuated head, provided for the receiving of the shoulder or arm-bone. Not far from this process is another, called Coracoides, for that the end thereof is crooked like a Crows beak. This keeps the shoulder-bone in its place, and conduces to the strength of that part.* 1.2 The shoulder-blade may be fractured in any part thereof, that is, either on the ridge, which runs like a hill, alongst the midst thereof for its safety, as we see in the ver∣tebrae of the back: So also in the broader part thereof, it may be 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.
We know the spine or ridge of the shoulder-blade to be broken, when a dolorifick inequality is perceived, by touching or feeling it: But you may know, that the broader or thinner part there∣of, is depressed, if you feel a cavity, and a pricking pain molest the part, and if a numness trouble the arm,* 1.3 being stretched forth. The fragments, if they yet stick to their bones and do not prick the flesh, must be restored to their state and place, and there kept with agglutinative medicines, and such as generate a Callus, as also with boulsters and rowlers fitted to the place: But if they do not adhere to the bone, or prick 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 Crows beak: But although they stir up and down, yet if they still adhere to the periosteum and ligaments, (if so be that they trouble not the muscles by pricking them) then must they not be taken forth: for I have oftner than once observed, that they have within some short time after grown to the adjacent bones. But if they, being wholly separated, do not so much as adhere to the periosteum, then must they necessarily be plucked away; otherwise within some short space after, they will be driven forth by the strength of nature,* 1.4 for that they participate not any more in life with the whole: For that which is quick, saith Hippocrates, uses to expell that which is dead far from it. The truth whereof was manifested in the Marquess of Villars, who at the battell of Dreux, was wounded in his shoul∣der with a Pistoll-bullet, certain splinters of the broken bone were plucked forth with the pieces of his harness, and of the leaden bullet; and within some short space after, the wound was cica∣trized,* 1.5 and fully and perfectly healed: But more than seven years after, a defluxion and inflam∣mation arising in that place by reason of his labour in arms, and the heaviness of his Armour at the Battell of Mont-contour, the wound broke open again; so that many shivers of the bone, with the residue of the leaden bullet, came forth of themselves. But if the fracture shall happen in the neck 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 Lorrain, Duke of Guise;* 1.6 the Count Rhingrave Philibert, and many other in these late civil Wars: For there are many large vessels about this dearticulation, to wit, the axillary vein and artery, the nerves ari∣sing from the Vertebrae of the neck, which are thence disseminated into all the muscles of the arm. Besides, also inflammation and putrefaction arising there, are easily communicated by reason of their neighbourhood to the heart and other principal parts, whence grievous symptoms, and oft-times death it self ensues.