Quotation from: Manual of Surgery

Written by: Alexander Miles and Alexis Thomson


Wounds inflicted by shell fragments and shrapnel bullets tend to be
extensive in area, and show great contusion, laceration, and destruction
of the tissues. The missiles frequently lodge and carry portions of the
clothing and, it may be, articles from the man's pocket, with them.
Shell wounds are attended with a considerable degree of shock. On
account of the wide area of contusion which surrounds the actual wound
produced by shell fragments, amputation, when called for, should be
performed some distance above the torn tissues, as there is considerable
risk of sloughing of the flaps.

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