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Updated: May 15, 2025
The elder, who was in the prime of youth and beauty, very large of limb, dark in colour, cried considerably; whilst the younger one, though very fair, had a snubby nose and everted lips, and laughed as if she thought the change in her destiny very good fun.
The depth of punctured wounds greatly exceeds their width, and the damage to subcutaneous parts is usually greater than that to the skin. When the instrument transfixes a part, the edges of the wound of entrance may be inverted, and those of the exit wound everted. If the instrument is a rough one, these conditions may be reversed by its sudden withdrawal.
When the charge impinges on one of the extremities at close range, we often have the opportunity of observing that the exit wound is larger, more ragged than that of entrance, and that its edges are everted; the extensive tearing and bruising of all the tissues, including the bones, and the marked tendency to early and progressive septic infection, render amputation compulsory in the majority of such cases.
On exposing the wound it is found that the parts for some distance around are red, glazed, and œdematous. The discoloration and swelling are most intense in the immediate vicinity of the wound, the edges of which are everted and moist. Any stitches that may have been introduced are tight, and the deep ones may be cutting into the tissues.
When the bullet perforates, the exit wound is usually larger and more extensively lacerated than the wound of entrance. Its margins are as a rule everted, and it shows no marks of flame, smoke, or powder. These features are common to all perforations caused by bullets.
This corresponds with the characteristic type of the satyr in classic statues as in later paintings; his lips are always thick and everted. Fullness, redness, and eversion of the lips are correlated with good breathing, the absence of anæmia, laughter, a well-fleshed face. This kind of mouth indicates, perhaps, not so much a congenitally erotic temperament, as an abandonment to impulse.
The curves at this stage depend on the attitude of the child while sitting or being carried for example, the arm bones become bent in children who paddle about the floor with the aid of their arms; and in a child who lies on its back with the lower limbs everted, the weight of the limb may lead to curvature of the neck of the femur coxa vara.
When there is actual destruction of tissue and ulceration the so-called "lupus excedens" or "ulcerans" healing is attended with cicatricial contraction, which may cause unsightly deformity. When the cheek is affected, the lower eyelid may be drawn down and everted; when the lips are affected, the mouth may be distorted or seriously diminished in size.
The edges, noting particularly whether or not the marginal epithelium is attempting to grow over the surface; also their shape, regularity, thickness, and whether undermined or overlapping, everted or depressed. The surrounding tissues, as to whether they are congested, œdematous, inflamed, indurated, or otherwise. Whether or not there is pain or tenderness in the raw surface or its surroundings.
The chest was thin and the lower ribs were everted; dulness began at the lower border of the 3d cartilage, and the apex-beat was best felt in the third space. Liver-dulness began at the 4th rib cartilage in the nipple line. The abdomen was enormously distended, and covered by large veins running from below upward to the thorax.
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