The wound is generally lacerated and contused and the mouths of
the vessels do not gape, but are twisted and crushed. The skin
usually separates at the highest point and the muscles protrude,
appearing to be tightly embraced and almost strangulated by the
skin, and also by the tendons, vessels, and nerves which, crushed
and twisted with the fragments of bone, form a conical stump.
Cheselden reports the history of a case, which has since become
classic, that he observed in St. Thomas' Hospital in London, in
1837. A miller had carelessly thrown a slip-knot of rope about
his wrist, which became caught in a revolving cog, drawing him
from the ground and violently throwing his body against a beam.
The force exerted by the cog drawing on the rope was sufficient
to avulse his whole arm and shoulder-blade. There was
comparatively little hemorrhage and the man was insensible to
pain; being so dazed and surprised he really was unconscious of
the nature of his injury until he saw his arm in the wheel.
According to Billroth the avulsion of an arm is usually followed
by fatal shock. Fischer, however, relates the case of a
lion-tamer whose whole left arm was torn from the shoulder by a
lion; the loss of blood being very slight and the patient so
little affected by shock that he was able to walk to the
hospital.
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