SOFTENING AND INDURATION. 



711 



are urethral strictures. Ulceration of the 

 stomach when healed, is followed by contrac- 

 tion of the cicatrix ; and when the ulcer has 

 extended into the duodenum from the stomach, 

 pyloric constriction of the severest kind occurs. 

 The colour of indurated mucous membrane is 

 generally paler than natural: the opposite may 

 occur, and the degree of density varies from 

 a slight increase to a bony hardness. 



An indurated and thickened state of the mem- 

 branes of the brain, pericardium, and pleura, 

 are found after long continued chronic in- 

 flammation, either of the membranes them- 

 selves, or of the parenchymatous structures 

 in their vicinity. Effusion of lymph behind 

 serous membranes always tends to their be- 

 coming harder and thicker than natural ; after 

 a while the lymph becomes organised and 

 contracts, and produces a puckering and ir- 

 regularity of the membranes. We find thick- 

 ening and induration of the pleura over large 

 tuberculous cavities, the peritoneum covering 

 the liver, and intestinal canal, and in the sacs 

 of old hernia?. Constriction of any part of 

 the intestinal canal, and also of the pylorus, 

 may be produced by sub-peritoneal effusion 

 of lymph. 



Softening of the liver usually occurs in a 

 manner not to be appreciated by the eye, being 

 simply easily broken down under the finger; 

 occasionally, however, the liver looks as if it 

 had been macerated for a great length of time 

 in a dark fluid, its texture has completely lost 

 its cohesion, and has become in certain spots 

 quite diffluent. Livers in a state of softening 

 may retain their ordinary colour, or it may be 

 increased, and even decreased, in an extraor- 

 dinary manner ; for, sometimes, no traces of 

 blood can be found, except in the larger venous 

 trunks, and the tissue of the liver is pale and 

 light drab in colour. Softening of the liver is 

 found frequently on the anterior and convex 

 surface, as a product of inflammation ; partial 

 and curable softening has been noticed to ac- 

 company inflammation of the right lung; and, 

 finally, the consistence of the liver is much 

 influenced by the abnormal deposition of fat, 

 which sometimes occurs in the ultimate cells 

 of the organ. 



Induration of t/ie liver is generally produced 

 by the deposition of lymph, its subsequent 

 contraction and its compressing influence 

 upon the lobules. This effusion is the con- 

 sequence of adhesive inflammation in the are- 

 olar tissue about the twigs of the portal vein, 

 serum and coagulable lymph are poured out, 

 thefirst is absorbed, and the latter consolidated, 

 and ultimately converted into dense fibrous 

 tissue, which divides the lobular structure of 

 the liver into well defined masses, gives great 

 density and toughness to the organ, by com- 

 pressing the small twigs of the portal vein, and 

 the small bile ducts, thus impeding the flow 

 of blood and the escape of bile, and causing 

 the usual yellow tint which accompanies this 

 disease. 



This deposition of fibrous tissue produces 

 different effects according to the parts it prin- 

 cipally involves. Sometimes the lymph is ef- 



fused exclusively into the cellular tissue of the 

 portal canals of considerable size, and if the 

 person die some time after this has occurred, 

 all the considerable branches of the portal 

 vein are found surrounded, in some places, to 

 the distance of half an inch, by new fibrous 

 tissue, which by its contraction has drawn in 

 and puckered the adjacent portions of the 

 liver. The remaining portions of the liver 

 may be little or not at all altered in texture, 

 and may be readily scraped away from these 

 indurated portions ; the main branches of the 

 portal vein are still pervious, but many of the 

 small branches leading from them are obliter- 

 ated, the parts which they supply atrophied, 

 and the liver correspondingly diminished in 

 bulk. When such portions are near the sur- 

 face, the capsule is drawn in, thickened and 

 puckered, and generally covered with false 

 membranes. 



In other cases, the fibrous tissue is not 

 found around the larger veins, but in the vi- 

 cinity of the small twigs that separate the 

 lobules ; all the substance of the liver is thus 

 rendered tough ; and when the organ is sliced, 

 the fibrous tissue is seen to form distinct lines, 

 between small irregular masses of lobules. 

 At the parts on the surface of the liver which 

 correspond to these lines, the capsule is drawn 

 in, so that the organ presents what is termed 

 a hobnailed appearance. The degree of hard- 

 ness is determined by the amount of the adven- 

 titious tissue, and, as a general rule, the denser 

 the organ, the paler its colour ; ordinarily, 

 the colour is pale grey, or resembles that of 

 impure wax ; and hence the term Cirrhosis. 



Induration of the liver occurs around 

 growths, abscesses, and hydatid cysts, and 

 may be produced by inflammatory action of 

 a specific or non-specific nature. 



Softening of the spleen is produced by an 

 altered state of the fluid which it contains 

 naturally, and by inflammatory action, or by 

 both causes. Softening produced by the first 

 means is common in low fever, intermittents, 

 and scurvy ; the fibrous element of the spleen 

 does not suffer ; but the blood, which is con- 

 tained within its meshes, loses its natural con- 

 sistence, appears to lose its coagulating power, 

 becomes dark, and is washed away, leaving 

 the white fibres intact, by a slight stream 

 of water. In softening from inflammatory 

 action the whole tissue of the spleen is dis- 

 organized ; it breaks down under the slight- 

 est pressure ; the external fibrous envelope 

 is much softer than usual ; and its internal 

 prolongation is totally destroyed. Both of 

 these kinds of softening occur, with or with- 

 out alteration, in the bulk and dimensions of 

 the organ. 



Induration of the spleen may also arise from 

 an abnormal state of the blood, and from in- 

 flammatory action. When the consistence of 

 the blood is altered, the spleen, which may or 

 may not be enlarged, cuts like liver or frozen 

 muscle ; and no great quantity of blood follows 

 the incision, the whole tissue being, in fact, 

 denser than usual. 



Inflammatory hardening may or may not be 



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