CHAP. VIII. OF A FRACTURED CLAVICLE.
The clavicle, if it be fractured transversely, sometimes unites very well of itself, and if it be not moved, may do well without a bandage; but sometimes, and especially when it is moved, it slides away; and generally the part next the breast lies over, and behind that next the humerus. The reason of which is, that it does not move by itself; but complies with the motion of the humerus: therefore, this standing still, the humerus is moved upon it. That part of the clavicle, next the breast, very seldom lies on the forepart; insomuch that men of great character in the profession have told us they never met with it; but the authority of Hippocrates is sufficient to put the fact beyond dispute.
However, as these cases are dissimilar, so each requires a treatment somewhat different from the other. When the clavicle flies back towards the scapulæ, the humerus must be pushed backward by the palm of the right hand, and at the same time the clavicle itself be brought forward. When turned to the breast, this must be forced backward, and the humerus brought forward; and if the humerus fall below the other, that part of the bone next the breast must not be depressed, because it is immoveable; but the humerus itself must be raised; but if it rise higher, the part next the breast must be filled with wool, and the arm bound down to the breast. If there be sharp pieces in the fracture, an incision must be made in the skin over it; and any parts of the bone, that wound the flesh, must be cut off; then the blunted bones must be brought together; and if there be a prominence any where, it must be kept down by a linen cloth, three times folded, dipped in wine and oil: if there be several fragments, they are to be covered with a splint, the inside of which is to be smeared with wax, lest the roller should slip on one side. The roller must be bound over the clavicle, when reduced, rather often than tight: and this rule holds in all fractures. In a fracture of the right clavicle, the bandage ought to pass from it to the left arm-pit; if, of the left clavicle, to the right; and again under the arm-pit of the affected bone: this done, if the clavicle be inclined toward the scapula, the fore-arm must be tied to the side; if forward, to the neck; and the patient laid on his back. All the other directions given before must be observed.
Now there are several bones that have very little motion, and are either hard, or cartilaginous, which are liable to be fractured, or pierced, or bruised, or fissured, as the malae, the breast-bone, scapula, ribs, spine of the hips, ancle-bone, heel, hand, and foot. The method of cure is the same in all these. If there is an external wound, that must be dressed with the medicines proper for it. While the wound is healing, a callus also fills up the fissures of the bone, or any vacuity that may be in it. If the skin is entire, and from the pain we infer that the bone is injured, there is nothing else to do but rest; and cerate must be applied, and tied on gently, till the pain is removed by the bone becoming sound.