Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. XIX. Of a FRACTƲRE of the SHOƲL∣DER-BLADE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Fractura Scapulae; and in English, A Fracture of the Shoul∣der-blade.

II. A Fracture may happen ei∣ther in its point, or top of the Shoulder, called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 (ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 extremus, sum∣mus, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, humerus) sum∣mitas humeri; or in the body of the Blade-bone it self, pro∣perly and more especially cal∣led Scapula, or Omoplata.

III. The Signs. If the Acro∣mion is broken, it is known both by sight and feeling, there being a certain unevenness in the Part, especially, if being compared with that which is sound.

IV. If the Scapula is broken in the middle part, it is known also by the touch, there being a certain Cavity felt: there is also a pricking Pain in the Part, and a numbedness is felt in the whole Arm, more especially if it is stretch'd directly out.

V. The Prognosticks. A Fra∣cture in the Acromion, or top of the Shoulder, is more difficultly Cured, than in any other Part of the Shoulder-blade.

VI. If the Blade-bone it self is broken, the Cure is generally per∣formed in about twenty-four days time.

VII. If the Neck of the Shoul∣der-blade is broken, or the Fra∣cture is in the Dearticulation of the Shoulder, it is scarcely ever Cured.

VIII. For since near about this Joint, there are the Arteries and Veins of the Arm-pits; and the Nerves arifing from the Vertebrae of the Neck behind; an Inflam∣mation, and other vehement Symptoms do generally hap∣pen.

IX. The Cure. First examine the Place and Circumstances of the Fracture, and see if the broken Bone does still adhere to the Shoul∣der-blade; if so, you are with your Hands to thrust back the Prominences of the Bones into their proper places.

X. But if this cannot be done easily, and that there is need of great strength, then a Ball of Linnen is to be put under the Arm-hole, and the Assistant is to draw the Shoulder down∣wards, by drawing about the Elbow unto the Ribs; and the Artist himself is with his Hand to press down the fractured piece of Bone, into its right place.

XI. If the broken Bone is wholly separated from the Scapula, but hangs by the Periosteum, and the Ligaments; and that no vehe∣ment Symptoms are induced by reason of the Pain; you are

then to restore it to its place again.

XII. But if the broken Bone is wholly separated both from the Sca∣pula, the Periosteum, and the Ligaments; or there happens to be any Splinters, which may prick the Nervous Parts, &c. you must then make an Incision in the Skin and Flesh, and those fragments are to be taken out, or their points are to be cut off.

XIII. But if they prick not, they are then to be left remaining; for Nature will at length expel of her own accord, those things which will not join with the rest; tho' sometimes it may be a conside∣rable time before it is done.

XIV. The Bones being re∣duc'd as well as may be, pro∣per Medicines are to be apply'd upon the Fraction; with conve∣nient Ligature or Bandage.

XV. A Bolster is to be laid up∣on the Scapula; and a large piece of Paste-board, of the bigness and Figure of the Bone, over which may be apply'd a small Bandage, resembling the Band-Cancer, or a Star, with a Swath five Yards long and four Inches broad, rowled up with one Head.

XVI. This Swath is to be car∣ried behind the Back, one of its ends lying under the Arm-hole op∣posite to the side affected; but the other is to go under the Shoulder, and afterwards above it, crossing the middle of the Back, and so running under the other Arm-hole; it is brought up to the Shoulder, to run down, and form a second Cross upon the middle of the Back: these Cir∣cumvolations are to be continu∣ed till the Scapulae are all cover∣ed; and Circumvolutions are also to be made round the upper Part of the Humerus or Shoul∣der, and then the Ligature is to be compleated by a Circumvo∣lution round about the Brest or Stomach.

XVII. If the Acromion is bro∣ken, a Linnen Ball is then to be bound under the Wing thereof, and the Ligature is not to be loosned before the seventh day, unless some Symptoms urge it.

XVIII. Lastly, Let the Pati∣ent lie on the opposite side, and let the Part affected be kept in as much quietness as may be.