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. XI. Of a DISLOCATION of the COLLAR-BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Dislocatio Claviculae; and in English, A a Dislocation of the Collar, or Channel-Bone.

II. The Clavicula is a crooked Bone, made almost like an S; one end of which being thicker, and almost three-square, is inserted into a cavity, designed by Nature for it, in the Sternum, and tied by a strong Ligamentous Membrane.

III. The other end is broad and flat, and joined to the Acromium; where it not only serves to keep the Shoulder at a due distance from the Sternum; but also assists those several Processes, which are designed to keep the Shoulder-Bone from slipping upwards from its cavity.

IV. It may be luxated two ways, and that only outwardly:

1. Where it separates from the Sternum, and presses outward, like a hard Lump. 2. At the broad end, near the Acromium; which may also be twofold, viz. upward, and forward; but no other ways, by reason of the adjacent Bones.

V. Yet these Luxations, seldom happen, by reason of the firm con∣nexion of the Clavicula with the Parts aforesaid: but being luxa∣ted, it is very difficultly retained when restored, because of the smoothness of his Head, and the small hold they have of the Acromium and Sternon.

VI. The Cause. It is caused by external violence; as of a Blow, or Fall, or Pitching on the Shoulder.

VII. The Signs. It is easily known, by the Prominence it makes: the Shoulder swells: and in the place where the Clavicula is slipt, there is an apparent ca∣vity.

VIII. Paraeus, lib. 15. cap. 11. says, he has known many Chirur∣gians, who have mistaken a Luxa∣tion of the Clavicula, for a Luxa∣tion of the top of the Shoulder: but they may be distinguished by their several Signs.

IX. In this case there is also Pain, and an Inflammation; and an impotency to move and lift up the Arm, or to do other things which are performed by the help of the Shoulder.

X. The Prognosticks. This Bone, as it is seldom luxated, so it is seldom well set; but hangs forth more or less from the upper part.

XI. But unless it is restored, the Sick will fail in some motion of his Arm; nor can he move his Hand, either to his Head or Month.

XII. The Cure. To reduce the Bone, let the Sick be laid upon some convex body, put between his Shoulders; both which are to be pressed backwards, to raise up the Clavicle: then he is to be set in a Chair, that the Artist strives to press the Clavicle and Acro∣mium, so as to join them.

XIII. Sennertus says, the Sick may lye upon his Back, with a Stone or hard Cushion under his Shoul∣der: and the Arm is to be ex∣tended, pressing it backwards or forwards, (as the Dislocation requires;) that the Shoulder and Brest may bunch forth outward∣ly; then with the Palm of your Hand press the Clavicula so raised, into its proper place.

XIV. This done, fit Medicines, and many Bolsters must be laid on; and the Part must be bound straitly; which but few Men can endure.

XV. Which end so ever of the Bone is luxated, Wiseman advises Reduction to be made, by drawing the Shoulder backwards, and by pressing the luxated end even with the Acromium; or to the cavity of the Bone of the Ster∣num, whence it departed.

XVI. And since neither of the places afford it much room, it will therefore require your greater Care and diligence; for if it is not exactly reduced, it will scarcely hold in, or right, 'till you have made your Applications.

XVII. You must have before∣hand therefore in a readiness, Cala∣plasms, Emplasters, Cerates, Com∣presses, and Swaths for binding:

Splints, whether made of Paste∣board, Scabberd, or Tin, are sometimes of use.

XVIII. The Swath or Bandage ought to be made up with two Heads, to come over the Shoul∣der, and under the Armhole; making so many circumvolu∣tions, as may retain the Dres∣sings close.

XIX. This being well done, the Arm must be kept up with a Scarf, Napkin, or Towel, and the Hand placed under the Brest: nor is it to be loosned, 'till you think the Bones are united, and the Pa∣tient is at ease, and has the free use of his Arm.

XX. Galen, in Hippocrat. de Articulis, Com. 1. Text. 62. saith, that he himself had a Luxation of this Bone, in the thirty-fifth year of his age; so great, that there was three Inches space between the Shoulder-blade and the Throat: and that he suffered so strait and strong a Ligation, that he could perceive the motion of the Arteries under his Throat.