of
the integument, there is always more or less bruising of the parts
beneath and around, and the subcutaneous lesions are much wider than
appears on the surface.

Wounds of this variety usually gape considerably, especially when there
is much laceration of the skin. It is not uncommon to have considerable
portions of skin, muscle, or tendon completely torn away.

Haemorrhage is seldom a prominent feature, as the crushing or tearing of
the vessel wall leads to the obliteration of the lumen.

The _special risks_ of these wounds are: (1) Sloughing of the bruised
tissues, especially when attempts to sterilise the wound have not been
successful. (2) Reactionary haemorrhage after the initial shock has
passed off. (3) Secondary haemorrhage as a result of infective processes
ensuing in the wound. (4) Loss of muscle or tendon, interfering with
motion. (5) Cicatricial contraction. (6) Gangrene, which may follow
occlusion of main vessels, or virulent infective processes. (7) It is
not uncommon to have particles of carbon embedded in the tissues after
lacerated wounds, leaving unsightly, pigmented scars. This is often seen
in coal-miners, and in those injured by firearms, and is to be prevented
by removing all gross dirt from the edges of the wound.

_Treatment._--In severe wounds of this class implicating the
extremities, the most important question that arises is whether or not
the limb can be saved. In examining the limb, attention should first be
directed to the state of the main blood vessels, in order to determine
if the vascular supply of the part beyond the lesion is sufficient to
maintain its vitality. Amputation is usually called for if there is
complete absence of pulsation in the distal arteries and if the part
beyond is cold. If at the same time important nerve-trunks are
lacerated, so that the function of the limb would be seriously impaired,
it is not worth running the risk of attempting to save it. If, in
addition, there is extensive destruction of large muscular masses or of
important tendons, or comminution of the bones, amputation is usually
imperative. Stripping of large areas of skin is not in itself a reason
for removing a limb, as much can be done by skin grafting, but when it
is associated with other lesions it favours amputation. In considering
these points, it must be borne in mind that the damage to the deeper
tissues is always more extensive than appears on the surface, and that
in many cases it is