CONTUSIONS AND BRUISES
In the living these injuries are accompanied with swelling, pain, and more or less discoloration of the part affected. Among malingerers it is not an uncommon practice to bruise the body to imitate the spots of purpura and scurvy. In scurvy, the condition of the gums common to that disease, and the state of the general health, will point to the true nature of the spots. The diagnosis of purpura will be assisted by noting the diffusion of the spots over the body. In old people purpuric spots frequently extend round the limbs, chiefly on one of the lower extremities. Many blood diseases are associated with ecchymoses and purpuric eruptions. Some persons are very easily bruised, and a pinch, by no means severe, will cause on their arms a severe bruise. Discoloration—ecchymosis—may take place in the skin, cellular tissue, muscles, or internal organs as a result of external injury, or it may be due to sudden and powerful contraction of a muscle or group of muscles. Not infrequently the discoloration does not appear over the seat of injury, but at some distance from it; and when the effusion is deep-seated, days may elapse before any discoloration of the skin takes place, and then it is not blue, as in superficial parts, but of a violet, greenish, or yellowish hue. A deep-seated ecchymosis may give no external sign of its presence; hence in all cases deep incisions should be made before an opinion is ventured as to the entire absence of this occurrence. This is very noticeable among the deep-seated muscles of a limb. In these cases, forty or fifty days may elapse before the deep-seated bruise shows its existence on the surface, and then only as irregular, yellowish, green, or bluish spots over the part. A very slight contusion, as a sprain of the ankle, may give rise to extended discoloration of the leg. An ecchymosis is not necessarily situated directly under the seat of injury. A blow given during life may not appear as an ecchymosis till after death. The change of colour in bruises begins at the circumference, and travels inwards. During the first three days the colour of the bruise is blue, bluish-black, or black; greenish on the fifth or sixth day; and yellow from the seventh to the twelfth. The extent of an ecchymosis depends greatly on the looseness of the cellular tissue. A slight contusion causes a slight redness and swelling, and may leave no mark on the dead body, unless death has taken place within thirty-six hours. Injuries of this kind sometimes leave a parchment-like hardness and discoloration of the skin. The part looks slightly depressed, due probably to the epidermis having been partly rubbed off, and the skin then drying. Similar marks are sometimes made by blisters. These marks may be produced on the dead body by friction and exposure to the air.
The diagnosis of ecchymosis from hypostasis has been given (see [p. 46]). A tolerably severe blow after death would be necessary to produce appearances similar to those produced by a slight one during life. In scourging, there are parallel ecchymosed lines, of small spots resembling petechiæ. An internal organ may be ruptured, and yet there may be no appearance of injury externally. The liver is the organ most commonly ruptured. The rupture is almost always longitudinal, and in some cases a portion of the gland is more or less detached. The spleen is also not infrequently ruptured; and this occurs most frequently in countries where ague prevails. Rupture of the lungs and brain is rare. When the pelvis is fractured, the bladder is frequently found ruptured.
Death in most cases is due to internal hæmorrhage or shock, when any of the internal organs are ruptured.
Can the appearance of a bruise be produced after death?—It is possible that the appearance of a bruise inflicted during life may be produced within two hours after death, and in some rare cases even after the lapse of three hours and a quarter (Christison); but these ecchymoses are limited in extent, and when large are due to a rupture in a vein which can be readily ascertained. The experiments of the late Sir Robert Christison, relating to this question, are detailed in the Edinburgh Medical and Surgical Journal, vol. xxxi. The amount of violence required after death to produce appearances like those made before death is such as would seldom, if ever, be inflicted on a corpse, and, therefore, where we find a well-marked bruise we ought to infer that it was made before death.
The following table, compiled from the experiments of Christison, may assist the diagnosis:
| During Life. | After Death. |
| 1. Swelling of the part. | 1. No swelling. |
| 2. Coagulation of the blood | 2. No such appearance, unless |
| effused into the adjacent | there is a rupture of a large |
| cellular tissue, with or | vessel in the neighbourhood |
| without tumefaction. | of loose cellular tissue. |
| 3. Incorporation of blood | 3. No such appearance produced |
| with the whole thickness | by a blow after death. |
| of the true skin, rendering | |
| it black instead of white. |
N.B.—Extensive effusion may occur without affecting the skin, but when the skin is so affected Christison thought it decisive of ante-mortem injury.
The Size and Form of a Bruise should be noted.
Why?
1. In Hanging and Strangulation.—The mark due to pressure of the cord on the neck in hanging runs obliquely round the neck; in strangulation, the mark encircles the neck. The mark is frequently interrupted, and may present very varied appearances in different parts of the neck. The mark of the knot may be found under the chin.
2. In Throttling.—The pressure exerted on the throat of the deceased by the fingers of his assailant may leave marks which may point to the means used to cause death.
3. In other Cases of Death by Violence.—The impression made by the weapon used may lead to the identification of the murderer. The marks left by the wards of a large door-key once led to the identification of the assailant.