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Medico-Legal Significance of Bruise

Written By : Prof (Dr) J.P.Saxena (M.B.B.S; M.D, F.A.F.Sc; LL.B.) Medicolegal Expert cum Toxicologist and Advocate
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A bruise is called a "Contusion"

This is seen as a bluish coloured area on the surface of the skin to begin with. This is due to the rupture of capillaries (small blood vessels ) and veins (vessels which carry impure blood). This leads to the escape of blood in the tissues (these are aggregations of specialised cells which are united to perform a function) under the skin and is called "Ecchymosis".

This is usually due to an injury produced by a blunt object like Lathi, Bamboo stick , iron rod,stone or by a blow from fist or boot or by a fall or by compression or crushing etc, besides being due to some diseases. The degree of violence required to produce a bruise varies from firm gripping to heavy blows. This may be superficial or deep in situation. Bruises are also found on the different organs of the body chiefly in vehicular accidents.

Effect of injury:-

The immediate result may not be visible as it may take  sometime for the bruise to appear. The changes produced will be 
those of-
1. Swelling (which will be painful).
2. Discolouration.
The discolouration becomes more marked with the lapse of time and show some colour changes as well.

Note- 1. It is always advisible that a medical officer should re-examine the body after 24 hours as by this time the bruises are very clearly visible.
2. Bruises produced at the time of death show little swelling.
3. Bruises become more marked in victims who survive for sometime.
4. Special photography should be used for demonstrating early bruises

Deep Bruise:-

It may not always be obvious. To confirm at post mortem examination, deep incisions (cuts) at common sites are made which show ecchymosis (collection of blood).It may be noted that -
1. The shape and severity of a bruise is related to the causative agent and the amount of violence.
2. The ecchymosis is extensive in soft, lax and vascular (richly supplied with blood) tissues (Modi).

Factors that modify a bruise -
The effect of injury producing a bruise is modified due to the following-

I. Condition and the type of tissue injured-
1. A bruise will be extensive and will occur easily at the places where skin is loose i.e. round the eyes, scrotum (a pouch which contains the testicles) and vulva (region of the external genital organs of the female).
2. It is less in areas which are tough and less supplied with blood i.e. scalp, palm of hand and sole of feet.
3. It may not appear in the abdomen even though the death may occur due to the passage of cart wheel and consequent rupture of internal organs(Modi).

II. Age of the subject - .
Children and old people tend to bruise more easily because the skin of the child is loose and delicate, the skin of the old is devoid of flesh and there is some pathological change in the circulatory system of the body..

III. Sex of the object-
As the women have more subcutaneous fat (fat under the skin), they bruise more easily.

IV. Texture and the colour of the skin-
In fair coloured persons, a bruise appears more easily than in the dark coloured persons.

V. Natural diseases -
The persons having hypertension (high blood pressure) and some other diseases of the circulatory system results in the production of extensive extravasation (collection blood in the tissues). The presence of diseases slows the absorption of this extravasation the colour changes are produced late.

Colour changes in a bruise-
The blood collected under the skin due to the tearing of the blood vessels is gradually absorbed. During this process of absorption, some colour change are seen. The blood consists of red blood cells (R.B.Cs) which have the matter Haemoglobin' (Oxygen carrying red pigment of the red blood cells). Due to the injury, these red blood cells disintegrate and 
the haemoglobin is acted upon by enzyme (An organic compound capable of producing a specific action). This produces the colour changes in the bruise and this gives an indication of the age of the bruise. The colour changes begin first at the periphery and later extend to the centre.

Age of a bruise-

(a) . To begin with, a bruise is red in colour.
(b). Within next 3 days, it appears blue or bluish black or brown or livid red.
(c) By the 5th or 6th day, it becomes greenish.
(d). Between 7th and 12th day, it becomes yellow. This yellow colour fades away gradually by the 14th or 15th day when the skin regains its normal colour.

1. The disappearance of colour changes depend on the circulation, so the disappearance is more rapid in healthy persons and is slow in less healthy, sick and old persons.
2. This depends also on the violence used. Slight force will produce a bruise which will disappear within a week or so, greater force may produce ecchymosis which may disappear within 3-4 weeks.
3. Bruises present on the deeper tissues do not show these changes in colour during the process of absorption.
4. Subconjunctival ecchymosis (Ecchymosis situated beneath the conjunctiva )- a membrane that lines the eyelids), does not show these changes. The ecchymosis here is first bright red which later becomes yellow and finally fades away.

Difference between antemortem (produced during life) and post mortem (produced after death) bruise

A bruise produced during life shows
1. Swelling
2. Colour changes (If the person survives for sometime)
3. Coagulation (Clotting) of the extravasated blood in the subcutaneous tissues and muscle fibres. These signs are absent if the bruise is produced after death.

Difference between accidental, homicidal and self inflicted bruise.

It is interesting to note that the bruises can be self inflicted besides being accidental or homicidal in nature.
A. An accidental bruise will show the following -
1. Presence of mud, sand or gravel on the body.
2. Bruises will be present at the sites where the body comes contact with the ground or other causative agent.
B. A homicidal bruise will show the following -
1. A bruise produced by a weapon will be of the shape corrosponding to the weapon of assault.
2. A bruise produced by the length of a "Lathi" will be elongated and irregular.
3. A soft cane will usually produce two parralel bruises with an intervening gap almost equal to the diameter of the weapon used.
4. A bruise produced by a whip or any other flexible substance may encircle the part of the body and may present an abraded surface at the end.
5. Small bruises on the neck associated with finger or nail marks indicate that a hand has been used to produce it. Bruises may be found as well on the inner side of thighs of females in the same way.
C. A self inflicted bruise is produced by an 
application of "Bhilawan"(Marking nut) or the root of the root of "Chitra"(Plumbago Zylanica) or the root of Chitra"(Plumbago Rosae) . These substances when applied to the skin of the body, cause irritation and itching. The person usually scratches the part with his nails.

These bruises have the following characters -
1. They are present on the accessible parts of the body.
2. These are dark brown in colour.
3. Their margins (ends) are covered with tiny vesicles (small sacs containing liquid)
4. The surrounding skin is red and inflamed.
5. The scrapings of the area give positive test, on chemical analysis, for the substance used.

Some points for defence-
For the purposes of defence, it is essential that the injury report should be correctly interpreted Those reports which have a mention of bruises can be critically examined on the basis of the foregoing informations and the points for defence can 
be drawn out. 
The following references and points will be of value:-
1. The Medical Officer may be asked to produce the evidence of second examination in case the victim was examined soon after the injury by a blunt object, fall or a blow. For this, the history sheet of the case and the original injury report should invariably be summoned and they should be analysed from the point of defence. The point regarding the second examination should be raised only if it benefits the defence.

2. The advantage may be taken of the description of the injury and the alleged weapon of assault may be eliminated by arguing on the shape of the bruise and its other characters, to suit the defence theory.

3. Advantage may also be taken of the incomplete description of the injuries as the mere writing of the presence of bruise is not sufficient particularly when the bruise is self inflicted and because of the fact that a "Post mortem lividity" also resembles a bruise. The detailed description will only reveal the fact.

4. (a) The age of the bruise can be argued on the basis of the colour changes. The advantage should be taken of the complexion of the victim and the site of injury. In dark coloured persons, it is not possible to see the changes according 
to the book description and there may be errors in the estimation of the age of injury . According to Gradwhol's Legal Medicine" An age of bruise can be roughly estimated from its colour. Immediately after infliction, it will be red,turning fairly soon to dusky purple or black, whilst after 4-5 days there is green discolouration which changes to yellow in 7-10 days, finally disappearing in 14-15 days. These colour changes take place from the periphery and the time may vary to the extent of 1-4 weeks". According to the Taylor's "Principles and practice of medical jurisprudence - part -I- " After 18-24 hours the blue or livid margins of the area become lighter, the whole area aquires a violent tint and before its final disappearance, passes successively through shades of red, brown, grey, yellow and lemon colour. During this time the area is increased or moves due to gravity." and " A bruise takes much longer durationin old than in young. The bruise in old may remain for 4-5 weeks. Bruises of soft loose tissues like that surrounding the eye are resolved faster."

5. Result of bruise -
Bruises. as a rule are simple injuries. They are seldom fatal unless associated with a rupture of an internal organ or crushing of tissues resulting in large drainage of blood. Note- However, several bruises, though trivial individually, may cause death due to shock.

6.Nature of bruise-
(a) The position and arrangement of bruises indicate the nature of bruise. It depends on its causation.
(b) A bruise produced by a fall is usually associated with the presence of sand, gravel or mud.
(c) The shape and size of bruise gives a hint towards the shape of the weapon used.
(d) Self inflicted bruises have special significance. The advantage can be taken of this fact if the site of the bruise corrosponds to the positions which are accessible to the hands - chiefly in cases of rape and injuries. The question may be raised in 
respect of sending the scrapings of the bruised area and the nails of the victim for chemical analysis to confirm if they are self 
inflicted. Care should be taken to note the fact if the person is left handed or right handed to corelate the sites of bruises for the purposes of defence. The witness can be cross examined also on the colour changes in these cases because these bruises do not show colour changes.

7. Antemortem and postmortem bruise-
It is at times advantageous to the defence to determine whether a bruise is antemortem or postmortem in origin. It is not unusual to find that the injury reports may have a mention of less number of bruises than that of the postmortem report of the same case particularly when the person dies after a transit from one place to another. It is difficult to account for this and sometimes the accompanying injuries which may be responsible for the death of the person may have been mentioned as" postmortem" in origin by the medical officer. In such cases the proof of the nature of bruises will of help to the defence to corelate the the defence theory. It is specially to be noted that the bruise which is produced by an injury or a fall immediately 
after death, closely resembles the one that is produced during life. This fact is of great importance. 

In antemortem bruise, there will be certain amount of swelling and it will show colour changes if the person survives for sometime after recieving the injury. These signs are absent in case of bruise produced after death, though discolouration may be seen.

Additional information of value for the defence:-
The defence lawyers should also make use of the following:-
1. The dates given in respect of the colour changes and the determination of the age of a bruise,is mostly derived 
from foreign books which describe about these changes as observed in the temperate climate whereas our country has a tropical climate.
2. A bruise is likely to be disfigured by putrefication.
3. It is extremely difficult to distinguish between an antemortem bruise and a bruise that is produced immediately 
after death.Sir Robert Christison has proved by experiments that it was difficult to distinguish between an antemortem bruise 
and a bruise that is produced within 3-4 hours after death using great force (Modi).
4. Postmortem staining resembles a bruise and a medical officer may make a mistake in identifying a bruise from a patch of postmortem staining at postmortem examination. The postmortem staining is found on the dependent parts of the body on 
the position in which the body was lying after death. It does not show colour changes as are found in case of a bruise.
5. Prinston and Goddon of South Africa have drawn attention to the fact that an artefact which simulates a bruise in tissues on the neck can be produced when removing the part at autopsy and this can certainly occur from the ruprture of the Pharyngo-oesophageal plexus (Gradwhol Page 279). 
6. A bruise may not appear at the site of injury but appear at a place remote from the place of injury due to gravity shifting of the extravasated blood (Gradwhol-page 278). Taylor's Medical Jurisprudence also mentions "Bruises are spreading and moving things".
7. In the presence of good muscle tone, as in boxers and trained atheletes, bruising is undoubtedly reduced in severity (Camps and Purchase - page 353).


References -
1. Modi's Medical Jurisprudence andToxicology - 18th edition
2. Taylor's Principles and practice of medical jurisprudence (Vol,. Ist and IInd) - 12th Edn.
3. Practical Forensic Medicine by Camps and Purchase - Ist Edn
4. Gradwhol's Legal Medicine -2nd. Edn.
5. Lyon's Medical Jurisprudence - 10th Edn.
And a number other books and articles

You may also contact the author for any query concerning this article:

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