Contusion

CONTUSION (from Latin contusio - bruise), a type of bruising that differs from ordinary bruises by the sudden indirect action of force on the entire body or on extensive areas of it. The most common are air contusions: from the explosion of large shells, mines, mines, bombs, explosions of ammunition, flammable and chemical substances, explosions in mines, etc. The question of the nature of the factors causing contusion has not yet been fully resolved. Sudden sharp disturbance of atmospheric pressure is the most acceptable explanation for the occurrence of air contusions. When heavy shells explode, especially when a large amount of explosives detonates, a sudden compression and forward movement of an air wave in a certain direction occurs, which sometimes delivers a blow of such force that entire city quarters are destroyed, windows are broken at considerable distances from the explosion site, and people are thrown across trenches. Behind this wave comes a zone of rarefaction. These sudden changes in atmospheric pressure can, in the opinion of some, cause gas embolism or the detonation 'lateral' effect of the shell on adjacent tissues rich in blood and other fluids. Frequent repetition of shell explosions during bombardments causes vibrational shaking of the air, which explains some of the contusion symptoms. If the shell explodes nearby, the main effect of air waves can be accompanied by the poisonous action of gases developed during the explosion; when a person is thrown to the ground, direct bruises from impact on hard objects may also occur. Age, constitution, previous general diseases, alcoholism predispose to the development of contusion consequences. When mines explode, earth collapses in trenches and shelters, during railway accidents, in mines, the impact of large masses on the body is not only strong but also prolonged, as a result of which compression occurs, for example, of the chest cavity. At autopsies, the picture is extremely varied. Sometimes no changes are found, while sometimes severe damage is present, for example, to the brain, lung tissue, hemothorax, tears and hemorrhages in other internal organs, or bone damage. Clinically, in fresh cases, bleeding from the ears, nose, larynx, urinary tract, gastrointestinal tract, and other organs has been noted. In such cases, the skin changes: turgor increases, it swells, and sometimes small hemorrhages are found in the skin. The body in such cases gives the impression of general swelling, distension, but without signs of subcutaneous emphysema. When contusion affects healthy people without predisposing factors for the development of the above-mentioned consequences, it often amounts only to transient stupor. In moderately severe cases, if there are no accompanying closed injuries, a picture similar to concussion is sometimes observed. In severe cases, the symptoms depend both on the addition of subcutaneous tissue and organ injuries, and on organic changes in the nervous system. When specific injuries are present, treatment of the latter is carried out according to general rules for such cases. In addition, drug therapy and physical methods are needed to raise the strength and nutrition of the patient.

A. Ozerov. Contusion of the brain - a collective concept that encompasses a series of various somatic and psychological signs. What is common to them is the etiological moment - the onset of these signs after a direct head injury or air contusion. Although occurring in peacetime, contusion of the brain is one of the most common nervous diseases during wartime. The nervous disorders in contusion of the brain are caused by mechanical and psychological factors. The former includes the effect on the sense organs (especially the auditory nerve) and the skin of air waves formed during the explosion of shells and their passage over a person. The psychological trauma consists in the expectation of a shell explosion, in a state of tension while staying on the front lines, before and during battle. Often both of these factors combine with each other. Repeated contusions, quickly following one another, are particularly likely to cause changes in the brain. Factors predisposing to contusion of the brain include fatigue from marches, lack of sleep, insufficient nutrition, so common during wartime. Individual predisposition also plays a role. Contusion of the brain is more often observed in neuropaths, persons from alcoholic backgrounds, psychopaths, and the mentally ill. However, contusion of the brain also occurs in persons who were previously completely healthy. One can speak of contusion of the brain only in the absence of gross lesions of the skull and its soft parts. Undoubtedly, in many cases of contusion of the brain, there is a patho-anatomical substrate, mainly in the form of microstructural changes: pinpoint hemorrhages into the brain, very mild meningitis, local edema of brain tissue, slight deformations in the structure of nerve cells and fibers. In very rare cases, contusion can also cause gross changes in the brain vessels in the form of hemorrhages and thrombosis of them. In many cases of contusion of the brain, it is necessary to assume the absence of structural changes in the presence of only shock. - The clinical syndrome of the acute stage of contusion of the brain is briefly as follows. The most prominent feature is disturbance of consciousness. The unconscious state lasts from several minutes to several hours. From this state, the contused pass into a severe state of stupor, which can last for days and even weeks; later, memory of this period usually disappears from the contused person's memory. Upon emerging from the stuporous state, contused persons complain of headache, dizziness, and a feeling of blood rushing to the head. A very common symptom is deafness, to which mutism is sometimes added. In rare cases, even in the acute stage, there are seizures - sometimes epileptic, sometimes hysterical in nature. The further course of contusion of the brain is extremely varied. It can be divided, somewhat schematically, into 3 main types: the commotional form, where signs of organic brain damage predominate; the hysteroneurotic form, without symptoms of organic damage, with clearly expressed psychogenic syndromes; and the mixed form, where hysterical and neurotic phenomena are accompanied by minor organic signs. The symptomatology of the chronic stage of contusion of the brain is unusually varied. Among the psychological disorders, hypochondriacal and depressive states are noted, often - a tendency to malingering. Neurotic symptoms are most common: headaches, irritability, reduced work capacity, insomnia. In most cases, disorders of the autonomic nervous system are sharply expressed: flushes of blood to the head, coldness of the extremities, lability of the pulse, sweating, dermographism. In the motor sphere, paralysis, adynamia, hypertonia, and the most diverse hyperkinesias are observed. In particular, tics, tremors, and contractures are observed. Disorders of gait are common and take the form of hysterical astasia-abasia. Tendon reflexes are usually increased. Disorders of sensitivity are among the most frequent and constant symptoms of contusion of the brain. Mostly, they also bear the imprint of hysteria: thus, these disorders often affect half of the body, strictly limited to the midline. However, individual cases of focal an- and hypalgesia occur, and these foci again do not correspond to either central or peripheral innervation. Among the sense organs, hearing is most often affected, with vision in second place. While the disorders in the sphere of sensitivity and sense organs in contusion of the brain do not differ from those in hysteria, motor lesions often have clinical details not found in ordinary hysteria. Through comprehensive examination of contused persons, the fact of lymphocytosis has been established (up to 62%, on average 50.5%; Khoshko, Hrytsevych); lymphocytosis persists in contused persons for 2-3-4 years (up to 46.5%, on average 38% lymphocytes). These data indicate that in contusion, one cannot always speak only of a psychological, hysterical reaction, but that in contusion there is a disease of the entire organism. Treatment of contusion of the brain in the acute stage consists of rest and symptomatic remedies (light diverting agents, bromides). After the contused person emerges from the stuporous state, he should be subjected - in the absence, of course, of gross organic signs - to psychotherapeutic treatment, and it should begin as early as possible. During the imperialist war in Germany, the Kaufmann method was widely used (see Kaufmann's method). Nonne, in treating contused persons, returned to hypnosis, often giving it the form of mass suggestion. Along with psychotherapy, strengthening treatment in the form of hydrotherapy procedures, being outdoors, and preparations of arsenic, iron, and phosphorus is appropriate. Treatment can be most rationally carried out in special nervous sanatoriums. Apparently, for the so-called "old traumatized," the greatest success should be expected from treatment institutions with work processes and a work regimen. - The prognosis in contusion of the brain should be made with great caution. In many cases, contusion of the brain leaves residual neuropsychic changes for many years. Sometimes the nervous phenomena it causes can be separated from the moment of contusion by many years of a clear interval; this especially applies to epileptic seizures.

M. Neyding