SOFTENING AND INDURATION. 



707 



cartilaginous hardness. General induration 

 affects either the whole or the greater part of 

 the brain : the degree of hardness never exceeds 

 the first variety. The induration is not al- 

 ways equal throughout the whole of the parts 

 affected, the central medullary parts usually 

 exhibiting a higher degree of it than the grey 

 substance. A section of the indurated por- 

 tions generally presents increased vascularity, 

 in the usual speckled and striated form ; yet 

 the reverse is occasionally observed, the brain 

 being preternaturally white. 



Induration of the spinal cord may be general 

 or partial. Billard found a spinal cord in a 

 child of a few days' old, which, without the 

 membranes, supported a pound weight. In 

 partial induration, the white, and not the grey, 

 matter is usually affected. For further re- 

 marks on the softening and induration of the 

 spinal cord, see the article NERVOUS CENTRES 

 (Abnormal Anatomy). 



Softening of the heart occurs as a diminished 

 state of the cohesion of the muscular structure. 

 It is a rare disease, and is produced by very 

 opposite causes ; from inflammation, from a 

 defective state of the nutrition of the organ, 

 with or without general anaemia, and from a 

 perverted state of the nutrition of the mus- 

 cular and cellular elements. The heart when 

 softened collapses on itself when empty, tears 

 with the greatest facility, and breaks down 

 with little pressure, the finger perforating its 

 substance and penetrating into its cavities with 

 great ease. Its colour varies, being sometimes 

 deep red and violet, at others dirty white, and 

 occasionally of a faint yellow hue. Soften- 

 ing of the heart may be general or partial, 

 superficial or deep-seated ; it may be confined 

 to the walls of a particular cavity, or to the 

 ventricular septum, or it may occur in small 

 patches, disseminated in the midst of the mus- 

 cular substance. Softening of the heart may 

 coincide with hypertrophy of its walls, or a 

 dilated state of its cavities, and Hope found it 

 in a case of angina pectoris. 



When found as a sequel of carditis, the 

 softening is of a dark tint, the fibres are dark 

 from the whole heart being gorged with venous 

 blood, soft and loose in their texture, being 

 easily separable, and compressed with facility 

 between the fingers. When accompanying 

 chronic carditis and co-existing pericarditis, 

 the white colour predominates, sometimes 

 being nearly superficial, and attended by peri- 

 cardial and sub-pericardial effusion. 



The yellow-coloured softening is found in 

 cases of local and general anaemia, in malig- 

 nant fevers ; and it sometimes has an inflam- 

 matory, as well as merely cachectic origin. An 

 abnormal deposition of adipose tissue in the 

 cellular structure of the heart, produces sof- 

 tening by affecting the nutrition of the mus- 

 cular fibres, which suffer also from the state of 

 system peculiarised by the above deposition. 



Induration of the heart is said to follow 

 carditis, and appears to be produced by the 

 effusion of lymph into the cellular tissue, 

 around the muscular fibres and beneath the 

 serous membranes ; by its contraction and sub- 



sequent hardening, it may pass into a sub- 

 stance almost equal to bone in hardness. 



It may exist in any part of the organ, the 

 whole of the apex and the columnae carneae 

 of the left ventricle were found indurated in 

 one case, and in another the walls of the ven- 

 tricles were tough, did not collapse, and 

 emitted on being struck, a ringing hollow 

 sound. We sometimes find partial softenings 

 and indurations in the same heart. 



Softening of the lungs generally depends 

 upon the presence of effused products of in- 

 flammation; for instance, in the engorged, he- 

 patised, and suppurative stages df acute pneu- 

 monia. It is worthy of remark, that, although 

 in the hepatised stage the lungs are heavier, 

 contain less air, and appear denser, still they 

 are more fragile, and on being pressed by the 

 finger break down. The more acute and re- 

 cent the inflammation, the greater the soften- 

 ing. When we press a healthy lung with the 

 finger, it gives to the touch on account of 

 the elastic state of the tissue ; but this is lost, 

 and an unusual resistance, easily broken through, 

 is produced by the loss of air, and the pre- 

 sence of lymph, compound granule cells, se- 

 rum, and an abnormal quantity of blood. 



In the third stage of pneumonia, softening 

 is produced by the alterations in the effused 

 products ; lymph, for instance, is converted 

 into a yellow friable matter, which subse- 

 quently becomes pus. In typhoid pneumonia 

 the softening is great, even in the first or con- 

 gestive stage. 



Softening of the lung may be produced by 

 an insufficient supply of blood. A part of a 

 lobe may be so indurated, that the vessels and 

 bronchial tubes passing through it become 

 blocked up ; the tissue which ought to have 

 been supplied by these becomes at first soft, 

 and finally gangrenous. 



Induration may occur in any part of the 

 lung, it may affect simply the bronchi and the 

 tissue in their immediate neighbourhood, or 

 the interlobular cellular tissue and the paren- 

 chyma may suffer. 



The bronchi after long continued and re- 

 peated attacks of inflammation are found in a 

 more or less indurated state, the hardening 

 being generally in the outer cellular coat, and 

 the cartilages of the larger tubes may become 

 as hard as bone. The lung in the vicinity is 

 generally denser than it should be. 



The interlobular cellular tissue may be 

 hardened at the same time as the lobules, or 

 separately ; it becomes more apparent than 

 usual, and acquires a density occasionally re- 

 sembling fibro-cartilage, and sometimes exer- 

 cises so compressing an influence on the 

 lobules, as to obliterate them. 



But it is as a sequel of inflammatory action 

 of long duration, that hardening of the whole 

 or part of a lobe is found ; the vesicular struc- 

 ture first suffers, the air vesicles are obliterated, 

 and, often enough, the bronchi and blood- 

 vessels of a certain magnitude. 



Such portions of lung are dense, not at all 

 friable, possess a peculiar crispness, and con- 

 tain little or no air. 



55 Z 2 



