. Railway surgery : a handbook on the management of injuries . ound ragged and torn, the boneprobably somewhat protruding, and splintered, with a por-tion of the muscle hanging in a blackened, shredded con-dition from the end of the stump (see Fig. 14). The skinadjacent and above is , ecchymotic, andbruised. The next class, in which the distal part is still at-tached, will present as a complete crush through the ex-tremity, pulpifying the soft parts and comminuting thebone. The skin is torn and loop-holed, through whichblackened muscular structures bulge. The remains ofthe ext
. Railway surgery : a handbook on the management of injuries . ound ragged and torn, the boneprobably somewhat protruding, and splintered, with a por-tion of the muscle hanging in a blackened, shredded con-dition from the end of the stump (see Fig. 14). The skinadjacent and above is , ecchymotic, andbruised. The next class, in which the distal part is still at-tached, will present as a complete crush through the ex-tremity, pulpifying the soft parts and comminuting thebone. The skin is torn and loop-holed, through whichblackened muscular structures bulge. The remains ofthe extremity, being flail-like, and the usual complementof soiled clothing of the part and the rubbish of the road,with which all is mixed, and the hand or foot (as the case CRUSHES OF THE EXTREMITIES. 147 may be) twisted upon itself among the debris, make a pic-ture quite appalling (see Fig. 57). There are cases in which no such mangling is found,the contour of the part being but little if at all changed, aline of bruised or ecchymotic scratches marking the loca-. Fig. 57.—Crushed Extremity, showing destruction of the tissues, with distal portion still attached. tion of the injury, with perhaps a buttonhole or twothrough the skin (see Fig. 12). If this condition is foundwhen a fast train has passed over the part, closer inves-tigation will prove that all beneath the skin is a massof pulp, and the fact that the outer covering of skin keepsitself intact is one of the peculiar conditions frequentlyfound, serving to mask the true destruction. Since a casein which the normal contour is preserved may be one ofthose in which the extremity, caught by a car wheel, has 148 RAILWAY SURGERY. been slid out of the way without being actually impinged,in spite of the history that it has been run over, the partsmust be examined closely and satisfactorily so as to elu-cidate the true condition of things. When the part is devitalized, the remaining end willbe pale, cold, pulseless, and without feeli
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