704 



SOFTENING AND INDURATION. 



Softening and induration in a physiological 

 sense, refer to those changes which occur in 

 the density of tissues and organs during their 

 development, growth, and decay ; whilst, in a 

 pathological sense, they refer to alterations in 

 the normal consistence, with or without actual 

 molecular change. 



In order to be able to distinguish morbid 

 alterations of cohesion, from those which oc- 

 cur in the natural course of things, it is neces- 

 sary to be well acquainted with the power 

 exercised by age, sex, and idiosyncrasy, in 

 modifying the density of the tissues. 



Softening and induration are but relative 

 terms, the standard of consistence is con- 

 stantly varying, both as regards the whole 

 body, or as regards organs and tissues. In 

 the foetal state all the tissues are soft, and 

 contain large quantities of fluid ; as develop- 

 ment proceeds, so do the parts gradually be- 

 come hard, not all equally so, for certain 

 tissues remain permanently soft in comparison 

 to others, which rapidly increase in density. 

 After birth, the hardening processes still con- 

 tinue, and it is not until the age of puberty is 

 passed, that all the tissues have attained their 

 highest stage of development. But the pro- 

 cess of natural hardening is interfered with, 

 or retarded, by peculiar idiosyncrasy and by 

 the influence of sex and occupation ; the 

 general firmness of the tissue of an athlete is 

 greater than that of those, who, although in 

 perfect health, happen to lead inactive and 

 sedentary lives ; it is greater as a general rule 

 in the male than in the female sex, and in the 

 sanguineous than in the lymphatic temper- 

 ament. 



As old age comes on, changes in the con- 

 sistence of the tissues occur, which are pro- 

 duced by the natural decay to which all 

 organized matter is subject ; thus the cellular 

 tissue, the serous and mucous membranes, 

 the muscles and tendons, bone, the brain 

 and nervous system, and particularly the 

 uterus and ovaries, sometimes acquire a de- 

 gree of hardness, equal to that which is known 

 to be produced by certain diseases. 



Finally, after death the whole organism is 

 affected by forces, which had little or no in- 

 fluence upon it during life ; the tissues are 

 subjected to the macerating influence of their 

 fluids, which may also act chemically upon 

 them. In the natural course of things, soften- 

 ing and putrefaction, and disorganization of 

 the ultimate atoms of our body occur, before 

 they are fitted to be assimilated into other 

 organized structures ; this decay increases as 

 time progresses, and is enhanced by a high 

 state of temperature and exposure to the air. 

 After death, hypostatic congestion of the cel- 

 lular tissue simulates the appearance that 

 this structure frequently presents, when af- 

 fected with inflammatory softening ; and the 

 macerating effects of the fluids, which had no 

 such influence during life, are seen in the 

 brain and spinal cord ; whilst the alimentary 

 mucous membrane suffers softening and dis- 

 integration from the peculiarities of the fluid 

 usually secreted by it. By recognising then 



the normal alterations of cohesion, and those 

 arising from post mortem causes, the attributes 

 of morbid softenings will become perfectly 

 apparent. 



Softening and induration are said to exist 

 without any structural change ; such is not 

 generally the case, indeed it is exceptional, 

 and were such a state only to be properly 

 termed softening and induration, many of the 

 most important and interesting pathological 

 facts would be unaccounted for. Softening and 

 induration are produced by a variety of causes, 

 and frequently co-exist in the same organ, or 

 one may supervene on, or cause, the other. 



Both softening and induration may be pro- 

 duced by inflammation leading, on the one 

 hand, to effusion of serum and pus, and on 

 the other to the deposition and subsequent 

 contraction and hardening of coagulable 

 lymph ; the one appears to be the result 

 of acute, and the other of subacute, inflam- 

 matory action. Active sanguineous conges- 

 tion produces in some organs the sensation 

 of diminished consistence, whilst in others, 

 especially in those surrounded by a dense 

 fibrous tissue as the testicle, hardening results. 

 In softening, the effused product of inflamma- 

 tion, appears not only to break down the 

 structure by infiltration, but also by its pres- 

 sure to impede the usual nutrition of the 

 part. 



The softening of an organ, induced by in- 

 flammatory action, is frequently confined to 

 one of the component tissues, especially to 

 the cellular tissue ; the readiness with which 

 the serous envelope may be stripped from off 

 a parenchymatous organ, depends more upon 

 the subserous cellular tissue, than upon the 

 other structures ; and, in like manner, the 

 softness of a whole organ is often assignable, 

 rather to the deficient tenacity of the mem- 

 brane which unites its lobules, than of the 

 proper tissue. 



Softening may be produced by causes totally 

 differing from those produced by inflammation ; 

 it may depend upon a deficiency or perverted 

 state of the blood, and an anaemic state of 

 the general system. For instance, in white 

 softening of the brain, the arteries, which 

 ought to have sufficiently nourished the af- 

 fected parts, fail to do so on account of their 

 being blocked up, more or less, by abnormal 

 deposits. In certain softened states of the 

 spleen, the blood contained in its parenchyma 

 loses its consistence, and becomes more 

 fluid than natural, from a perverted state of 

 its constitution ; and the flabby muscles and 

 general loss of tone of anaemic subjects are 

 notorious. 



In scrofula, the perverted state of the gene- 

 ral nutrition produces softening of peculiar 

 tissues, for instance, of the bones j and in the 

 cancerous cachexia like effects occur. 



Long continued functional inactivity, for in- 

 stance of the muscles of an extremity stricken 

 with paralysis, tends to produce softening ; 

 and pressure, in certain instances so interferes 

 with the nutrition of a part as to diminish its 

 cohesion. Fatty deposit in the ultimate cells 



