Dr. Ogston, who cautiously avoids committing himself to the belief in “spontaneous combustion,” yet thinks that the subject of preternatural combustibility in certain conditions of the body may perhaps, to say the least of it, be set down as one still sub judice. “There is no evidence to justify the use of the word ‘spontaneous,’ but there can be no doubt that an extraordinarily high degree of combustibility occurs in rare instances, to which the term preternatural combustibility would more correctly apply” (J. Dixon Mann).
Burns due to X-Rays
Over-exposure to the action of X-rays produces burns of a peculiar character, and in cases of unprotected skin exposed to the action of the rays in those who are constantly working with them, forms of dermatitis have arisen which are intractable and tend to become epitheliomatous in character.
The results of slight over-exposure, or repeated short exposures vary from a simple redness of the skin to severe dermatitis, the hair of the part being shed. When the over-exposure or dosage has been severe, the skin may vesicate and ulcerate. I have seen this in cases where the rays have been used for reduction of the spleen in leukæmia and Banti‘s disease. The burns heal with cicatrisation of radiate shape, the skin around the scar being permeated with numerous capillary vessels which produce the appearance of capillary nævi, and in other instances large stellate superficial vessels are formed. In addition, marked pigmentation of the skin may follow the burn. X-ray burns which have produced vesication and ulceration or sloughing take a long time to heal in comparison with ordinary burns.
In repeated exposure to the rays, even when little redness has been noticed at the time, the formation of capillary vessels may become evident some time after the exposures have been stopped. This may cause disfigurement, by the formation of telangiectasis, especially if they appear on the face or neck. The falling out of the hair is produced by X-rays as a therapeutic measure in cases of ringworm, and due precaution must be taken to limit the effect and area of exposure by proper screening. The same precaution should be used to protect parts of the body other than the part which requires treatment or examination in other conditions.
With increasing knowledge of the effects of X-ray exposures, special precautions have been devised to prevent untoward effects, so that burns from over-exposure, and dermatitis amongst X-ray workers are prevented.
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.