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On The Articulations   


with an auger or a saw, or with a hatchet, and can dig, by not raising
the elbow too much, and do all other kinds of work which are done in
similar attitudes.

13. In those cases where the acromion has been torn off, the bone
which is thus separated appears prominent. The bone is the bond of
connection between the clavicle and scapula, for in this respect the
constitution of man is different from that of other animals;
physicians are particularly liable to be deceived in this accident
(for as the separated bone protrudes, the top of the shoulder
appears low and hollow), so that they make preparations as if for
dislocation of the shoulder; for I have known many physicians,
otherwise not inexpert at the art, who have done much mischief by
attempting to reduce such shoulders, thus supposing it a case of
dislocation; and they did not desist until they gave over mistake of
supposing that they had reduced the shoulder. The treatment, in
these cases, is similar to that which is applicable in others of a
like kind, namely, cerate, compresses, and suitable bandaging with
linen cloths. The projecting part must be pushed down, and the greater
number of compresses are to be placed on it, and most compression is
to be applied at that part, and the arm being fastened to the side
is to be kept elevated; for thus the parts which had been torn asunder
are brought into closest proximity with one another. All this should
be well known, and if you choose you may prognosticate safely that
no impediment, small or great, will result from such an injury at
the shoulder, only there will be a deformity in the place, for the
bone cannot be properly restored to its natural situation, but there
must necessarily be more or less tumefaction in the upper part. For
neither can any other bone be made exactly as it was, which having
become incorporated with another bone, and having grown to it as an
apophysis, has been torn from its natural situation. If properly
bandaged, the acromion becomes free of pain in a few days.

14. When a fractured clavicle is fairly broken across it is more
easily treated, but when broken obliquely it is more difficult to
manage. Matters are different in these cases from what one would
have supposed; for a bone fairly broken across can be more easily
restored to its natural state, and with proper care the upper part may
be brought down by means of suitable position and proper bandaging,
and even if not properly set, the projecting part of the bone is not
very sharp. But in oblique fractures the case is similar to that of
bones which have been torn away, as formerly described; for they do
not admit of being restored to their place, and the prominence of
the bone is very sharp. For the most part, then, it should be known,
no harm results to the shoulder or to the rest of the body from
fracture of the clavicle, unless it sphacelate, and this rarely
happens. A deformity, however, may arise from fracture of the
clavicle, and in these cases it is very great at first, but by and
by it becomes less. A fractured clavicle, like all other spongy bones,
gets speedily united; for all such bones form callus in a short
time. When, then, a fracture has recently taken place, the patients
attach much importance to it, as supposing the mischief greater than
it really is, and the physicians bestow great pains in order that it
may be properly bandaged; but in a little time the patients, having no
pain, nor finding any impediment to their walking or eating, become
negligent; and the physicians finding they cannot make the parts
look well, take themselves off, and are not sorry at the neglect of
the patients, and in the meantime the callus is quickly formed. The
method of dressing which is most appropriate, is similar to that
used in ordinary cases, consisting of cerate, compresses, and
bandages; and it should be most especially known in this operation,
that most compresses should be placed on the projecting bone, and that
the greatest pressure should be made there. There are certain
physicians who make a show of superior skill by binding a heavy

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