§ I.
1. Man enjoys an advantage which nature has bestowed on but few of the
quadrupeds, namely, a power of moving his upper extremities in every
direction. The clavicle being a kind of arch placed between the breast
and shoulder, forms a centre, moveable indeed but solid, for these
motions, a part of which can no longer be performed, when this arch, in
consequence of being broken, ceases to afford them a point of support.
Hence it follows, that the fracture of this bone may be said to reduce
the individual who sustains it, when considered in relation to its
functions, to a level with that numerous division of animals that are
destitute of clavicles.
2. Few diseases of the kind are more frequently met with than this.
The natural curve of the clavicle, its situation immediately under the
skin, the want of a support to its middle part, the great proportion of
spongy substance which enters into its composition, the projection of
the shoulder exposing it to the action of external bodies; all these
circumstances concur in rendering the accident frequent, particularly
among that class of men subject, from their occupations, to violent
exertions of the upper extremities.
Here then, more than in the generality of fractures, we should feel
an interest in the advancement of the art of surgery; and yet,
having hitherto employed in it but feeble means, our efforts have
been attended with imperfect success. Hippocrates has observed, that
some degree of deformity almost always accompanies the reunion of a
fractured clavicle; all writers since his time have made the same
remark; experience has confirmed the truth of it, and as much time has
been spent in hypothetical speculations to explain the accident, as in
serious inquiries how to prevent it. At length Desault proved that a
feeble and unskilful mode of treatment was the sole cause of a want of
success, and that, by being more correct and judicious, art might be as
successful here, as in other fractures. In order to give a correct view
of his practice in this disease, I will examine the causes, varieties,
and signs of a fracture of the clavicle; the accidents of which it is
susceptible; the mode and the causes of the displacement of the broken
ends of the bone; the indications that arise out of those causes, and
the manner of answering these indications as well during, as after, the
reduction.
§ II.