(From contundo, to bruise). Contusio, collisio, phlosma. Contused wounds, contusions, or bruises. When any part is bruised, the small blood -vessels are broken, and the blood they contained, effused in the adjoining cellular membrane; or these vessels lose their tone, and no longer contributing to the circulation, their contents stagnate. In either of these cases, if the impediment is not removed, an inflammation comes on, followed by suppuration, sometimes by gangrene. There are also peculiar symptoms from any injury done to a nerve, a blood vessel, or a bone.
In general, the symptoms consequent on bruises may be reduced to three classes.
First, They arise either when the solids are destroyed, and the fluids they contain discharged: those functions are consequently abolished which depend upon a due and determinate motion of the fluids through the sound vessels.
Secondly, The discharged fluids, collected either in the natural or preternatural cavities of the body, by their bulk and quantity press upon the adjacent parts, and either totally destroy or at least disturb their respective functions.
Thirdly, The humours thus discharged, may, by their continuance and stagnation in their cavities, acquire such a degree of acrimony as to corrode and destroy the adjacent parts.
When the internal parts are bruised, and the external integuments are entire, or confine the extravasated fluid, the consequence is, 1. An echymosis. 2. A spurious aneurism. 3. A sugillation. 4. Ulcers and gangrenes. 5. Caries; or, 6. Scirrhus.
Boerhaave observes, that contusions on fleshy parts may produce suppuration, gangrene, palsy, or a contraction. On a large nerve, a palsy, atrophy, incurable insensibility, and a gangrene on all their parts below the injured part: this may peculiarly follow contusions of the spine and its marrow. Contusions of the viscera, he justly observes, are often speedily fatal; they are tender; and their vessels easily burst.
Contusions from gun shot wounds are dangerous from the destruction of the organized parts which are bruised, as well as from the general concussion that the whole body suffers from the air violently impelled against it. The effects of concussion we have already noticed, though we have been unable to explain them. In no case should we be more cautious of pronouncingon the event of any disaster, than where a concussion or a contusion happens; and where both may have occurred, the caution, if possible, should be greater. See Bohnius de Renunciatione Vulner. § 2. cap. 1.
When bruises arc received inwardly, it is not easy to judge readily of the extent of the injury done by them ; and when the case becomes more manifest, it is often too late to attempt relief. See Concussion.
The remedies must be those chiefly which, by their stimulus, restore the tone of the vessels. For external use, where the skin is not much destroyed, a mixture of sharp vinegar, with twice its quantity of water, may be applied frequently by means of linen cloths wrung out of it, and, as often as they dry, moistened again. If there is much inflammation present, the following, called embrocatio ammonia acetate cum sapone, acetated Ammoniated Embrocation With Soap, is Very useful. Aq. Ammoniae, acetatae solutionis saponis aa. 1. m. But where the inflammation has subsided, two drachms of aqua ammoniae purae added to the above is considered as very efficacious. Spirituous applications should not be used, except where the sole intention is to strengthen the injured fibres immediately on the occurrence of the accident; in slighter cases, a small quantity of spirit may be mixed with vinegar, and used on the first reception of the bruise. Even such friction as the bruise will bear on the part, or around it, will be generally useful. See Discutients.
If the bruise is considerable, and particularly if any internal part is affected, bleeding, a cooling liquid diet, with repeated gentle purgings, are of the greatest advantage. If the bruise is in the lower belly, clysters are necessary; and where the internal parts are greatly affected, leeches or blisters, as near the seat of the complaint as can be admitted, are useful. Poultices, which were formerly applied to carry on the circulation by relaxing the over distended vessels, are now disused, as they are found to promote suppuration. Cold vinegar poultices act as stimuli; but cold, in the other forms, is seldom admissible, as the vessels are too weak to restore the action. This remedy is, however, useful in relieving the weakness which is often the consequence.
The advantages of the tinct. opii externally as a resolvent, of Dover's powders, and the anodyne antimo-nial drops, recommended in the article Concussio, deserve the same attention when contusions happen, and on the same principles.
See Bohnius de Renunciatione Vulnerum; Van Swie-tan's Commentaries on Boerhaave's Aphorisms; Tis-sot's Advice to the People; Bilguer's Dissertation on the Inutility of amputating Limbs, p. 69, 73. Bell's Surgery, vol. v. 446.