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mistaken for ecchymosis, but they can be easily distinguished from their
number, size, and symmetrical situation  (generally on the legs)   and frorn^
the absence of abrasions over the spots.    Subcutaneous haemorrhage^^
also result from great muscular exertion as in epileptic seizures.   Th^-e are
usually numerous, but smaller in size.

Subconjunctival ecchymoses due
to the rupture of small vessels
may occur directly from a blow
to the eye or indirectly from a
blow or fell on the head. They
are often seen in children suffer-
ing from whooping cough, and
may sometimes result from
severe straining during sneezing,
coughing, vomiting, or lifting
heavy weights, especially in old

Sometimes blebs and bullse
may form over the injured part,
especially when ecchymosis is
caused by an oblique and glanc-
ing blow or by fracture of a bone.

Result of Bruises.—Bruises are,
as a rule, simple injuries. They
are seldom fatal unless accom-
panied by the rupture of an
internal organ, or by extensive
crushing of the tissues and large
extravasation of blood, producing
sloughing and' gangrene of the
parts. However, several bruises,
though trivial individually, may
cause death from shock.

In June 1910, Musammat Bullo, 13
years old, was beaten to death by her
husband and father-in-law for neg-
lecting the household duties. Post-
mortem examination showed that
death occurred from shock due to
twenty-nine simple bruises inflicted on
various parts of the body.

Age of a Bruise,—The age of a bruise may be ascertained from the colour
changes which its eccliyrnosis undergoes during absorption. These^colour
changes are due to the disintegration of the red blood cells and staining of
tbe haemoglobin thus set free. They commence at the periphery and extend
inwards to the centre, They are red at first, but during the next three days
they appear blue, bluis^Hack, brown or livid red, and become greenish
from the fifth to the sixth day, and yellow from the seventh to the twelfth
day. 3Ms yellow colour slowly fades in tint till the fourteenth or fifteenth
day when the skin regains its normal appearance. Moreover, its disappear-
ance is more rapid in healthy persons than in sickly arid, old people with
feeble circulation. It also depends on the nature of the violence tisecL
Ecchymosis caused by slight force will disappear in about a week or two,
while an extensive oae caused by considerable force will disappear in about
tbree t*> four w^eks. It must be remembered that the colour changes are
IK>| seen so well on dark skins as on fair skins.

Iksehymoses situated in the deeper tissues do not exhibit any gradations
of superficial colour ctaages during their absorption. Subconjunctival

Fig. 76.—Contusions caused by blows
from a blunt weapon  (stick).