BRUISE, or CONTUSION, signifies an injury inflicted by a blow or sudden pressure, in which the skin is not wounded, and no bone is broken or dislocated. Both terms, and especially the latter, are employed in surgery to include all such injuries in their widest range, from a black eye to a thoroughly crushed mass cf muscle. In the slighter forms of this injury, as in ordinary simple bruises, there is no tearing, but only a con cussion of the textures, the utmost damage done being the rupture of a few small blood vessels, which occasions the discoloration that is always observed in these eases. Iu more severe contusions, the subjacent structures—muscles, connective tissue, vessels, ete.—are more or less ruptured, and in extreme cases, are thoroughly crushed, and usually become gangrenous. The quantity of blood that is extravasated mainly depends upon the size and number of the ruptured blood-vessels, but partly also on the nature of the textures of the injured part. Thus, a lax tissue, as that of the eyelids, favors the escape of blood into the surrounding parts. Moreover, the constitution of the patient has some influence, and many persons, especially (according to Mr. Paget, in his article on "Contusions" in Holmes's System of Surgery, vol. i.) pallid, fatty, soft-skinned women, though suffering from no apparent disease, are subject to extravasations, and consequently to discolorations, very disproportionate to the injuries that cause them.
The most characteristic signs of a recent contusion are more or less shock (cf.v.), pain, swelling, and discoloration of the surface from effused blood (commonly known as ecchymosis, q.v.). There is nothing special in the character of the shock, but it is worthy of notice that it is most severely felt in injuries of special parts—as the testes, the breasts, and the larger joints, which are often followed by remarkable general depression, faintness, loss of muscular power, and nausea. The immediate pain fol lowing the blow is succeeded by a feeling of numbness, which, after a varying time, unless the part is killed, gives place to a heavy, aching pain. Although some depression may usually be observed immediately after the infliction of the blow, swelling of the parts rapidly follows, as may be well seen in the case of a child receiving a blow on the head, or of the wale that rises after the lash of a whip. In lax parts, such as the eyelids, the swelling is often considerable, and may remain for a week or more; but in other parts, it usually subsides in two or three days. The discoloration of the skin consequent on blows is of a more or less purple tint, varying from black to crimson or pink. "Black ness," says Mr. Paget (op. cit.), indicating intense injury, is probably due to the extravasation of a large portion of entire blood; crimson or pink tints, to the preva lence of a blood-stained fluid; blue, to the degrees in which blackness is veiled by the cuticle and skin, as the color of blood in veins is; and perhaps some of the shades of pink to the partial aeration of the blood by the penetration of air through the epidermis. After a variable time, proportionate to the severity of the injury, these colors fade out, passing most commonly through gradually lightening shades of brownish olive, green, and yellow." The causes of these changes of color are not clearly known; as, however,
the changes are not observed in bruises of parts removed from air and light, they are probably due to oxidation and actinic agency. When a severe B, tends to a natural cure, and there is no inflammation or sloughing, the effused blood is generally absorbed. the liquid portion rapidly disappearing, while the blood-cells are more slowly removed. In some cases, it is probable that the effused blood becomes organized into vascular connective tissue, which takes part iu the repair of the injured tissue. We need not fol low the course of a B. in which active inflammation with suppuration ensues, or in which sloughing takes place, as these complications must be treated according to the ordinary rules of those affections. There are, however, one or two ill consequences following partial recovery, which require notice. Thus, in some organs, as the breast, abscess may ensue long after a blow; or a sensitive indurated lump may remain; or (more com monly) there may be long-continued pain, without change of texture; or, lastly, cancer may ensue. Blows on superficial bones, as those of the skull. are not unfrequently fol lowed by very painful thickening of the periosteum; and a muscle violently struck may be paralyzed, and rapidly waste away; and constitutional diseases, such as gout and rheumatism, are well known to localize themselves with special severity in parts that have once been seriously bruised.
With regard to treatment, simple and not very severe bruises require little treatment but the.rest necessary for the avoidance of pain; but the removal of the swelling and discoloration may be hastened by the application of various local stimulants, which seem to act by accelerating the circulation through the bruised part, and promoting the absorption of the effused fluid. Friar's balsam, compound soap liniment, or poultices made with the roots of black bryony beaten to a pulp, are popular remedies of this class. Mr. Paget regards the tincture of arnica as the best application. Where the skin is thick, it may be gently rubbed over the bruised part in an undiluted state; where the skin is thinner, it should be mixed with an equal bulk of water; or, which is probably better, it may be constantly applied as a lotion if diluted with five or six parts of water. Pugil ists, who are probably better acquainted with ordinary bruises than any other class of men, are in the habit of removing the swelling of the eyelids that often naturally occurs during a prize-fight, to such an extent as to close the eyes, by at once puncturing the eyelids at several points with a lancet; and their favorite remedy for a black-eye or other B. on the face is a fresh beef-steak applied locally, as a poultice. Bruises of a more severe nature, as when there is mdch breaking or crushing of the tissues, must, of course, at once be placed in the hands of a surgeon.—For further details on this subject, the reader is referred to Mr. Paget's excellent article, from which we have freely quoted.