Part 21

Though all the fibrous organs have precisely the same nature, and though the same fibre enters into the composition of all, yet the forms which they assume are extremely various; it is this variety of form, joined to that of their position and their functions, which has given them a different denomination, and made us designate them by the name of tendons, aponeuroses, ligaments, &c.; for there is no general denomination for the whole system, no word which answers for example to that of muscle, nerve, &c. which in the muscular, nervous systems, &c. gives an idea of the organization, whatever may be the form of the organ. I shall not create a word, I shall be easily understood without it.

All the fibrous forms can be referred to two general ones; one of these is membranous, the other in fasciæ. The organ is broad and thin in the first; it is longer and thicker in the second. Thus the muscles, the nerves, the bones themselves exhibit alternately this arrangement in their conformation, as we see in the retina compared with the round nerves, in the muscular layers of the stomach and the intestines, compared with the muscles of locomotion, and in the bones of the cranium compared with those of the extremities.

I. _Of the Fibrous Organs of a Membranous Form._

The fibrous organs arranged as membranes are, 1st, the fibrous membranes, properly so called; 2d, the fibrous capsules; 3d, the tendinous sheaths; 4th, the aponeuroses.

1st. The fibrous membranes comprehend the periosteum, the dura-mater, the sclerotica, the albuginea, the peculiar membranes of the kidney, the spleen, &c. &c. They are in general destined to form the covering of certain organs, into the structure of which they enter.

2d. The fibrous capsules, very distinct, as we shall see, from the synovial surfaces, are a kind of cylindrical sacs, which are found around certain articulations, especially those of the humerus and the femur, whose connexions with the scapula and the ilium they strengthen, by embracing with their two extremities, both surfaces of the articulation.

3d. The fibrous sheaths are destined to confine the tendons in their passage upon the bones, where they are reflected, and generally wherever by muscular contraction they would be made to deviate and consequently transmit with difficulty to the bones the motion they receive from the muscles. They may be divided into two kinds; one receives and transmits the tendons of many muscles united, as is seen at the wrist, the instep, &c.; the other, like that of the fingers, is destined for a single tendon, or two only.

4th. The aponeuroses are a kind of fibrous nets more or less broad, entering always into the system of locomotion, and so arranged that they sometimes form coverings for different parts, and sometimes furnish the muscles with points of insertion. Hence the aponeuroses of covering and the aponeuroses of insertion; each of them is divided into species.

The aponeuroses of covering are placed sometimes around a muscle, to which they serve as a general sheath, as we see on the thigh, the fore-arm, &c.; sometimes upon certain muscles which they partially retain in their respective places, as that which goes from the posterior and superior serratus minor to the anterior and inferior, as the abdominal aponeurosis, as that situated anteriorly to the solæus, behind the deep muscles of the leg, &c.

The aponeuroses of insertion are sometimes with surfaces more or less broad, as in the attachments of the triceps femoris, the rectus, the biceps, &c.; sometimes with fibres separate from each other, and giving attachment by each of these fibres to a fleshy fibre, as at the superior insertion of the iliacus, of the anterior tibialis, &c.; sometimes finally in the form of an arch, and then at the same time that they give the muscles points of insertion, they allow vessels to pass under them, as in the diaphragm, the solæus, &c.

II. _Of the Fibrous Organs in the form of Fasciæ._

The fibrous organs arranged in fasciæ are, 1st, the tendons; 2d, the ligaments.

1st. The tendons are found at the origin, insertion or middle of the muscles. They are either simple, in the form of elongated cords, as in the peronæus, the tibialis, and almost all the muscles, or compound, as in the rectus, the flexors, &c.

2d. The ligaments strengthen the osseous or cartilaginous articulations, around which they are found. They have regular fasciæ, as the lateral ligaments of the elbow, the knee, the jaw, &c.; or irregular fasciæ, as those of the pelvis.

III. _Table of the Fibrous System._

We can in the following table present at a single view the classification of the fibrous organs that I have just pointed out.

┌ ┌Fibrous Membranes. │ │Fibrous Capsules. │ │ ┌Partial. │Of a membranous │Fibrous Sheaths. └General. │ form. │ ┌Partial. │ │ ┌For covering └General. FIBROUS │ │Aponeuroses │ ORGANS. │ │ │ ┌With a broad surface. │ └ └Of Insertion│In an arch. │ └With separate fibres. │ │ ┌Tendons ┌Simple. │In the form │ └Compound. │ of fasciæ. └Ligaments ┌With regular fasciæ. └ └With irregular fasciæ.

Though the numerous organs which enter into this classification, belong to very different apparatus, though they seem to be spread here and there in the economy, without holding together at all, and though all appear insulated, yet they are almost all continuous and connected; so that we may consider the fibrous system, like the vascular and cerebral nervous systems, that is to say, as having a common centre, from which all the different organs go that form its divisions.

This common centre of the fibrous system appears to me to be the periosteum, not that I pretend that like the heart or the brain, it sends out radiations upon the organs that go from it, but because anatomical inspection shows us that all the fibrous organs are intimately connected with it, and by its means communicate with each other; the following observations are a proof of this.

1st. Among the fibrous membranes, that of the corpus cavernosum intermixes with the periosteum below the ischium; the dura-mater is continued with it through the foramina at the base of the brain; by uniting itself by the lamina which accompanies the optic nerve to the sclerotica, it joins to it this membrane, and thus serves as an intermediate organ for them. 2d. All the fibrous capsules above and below the articulation intermix with the periosteum. 3d. Wherever fibrous sheaths exist their fibres intermix with those of the periosteum. 4th. All the aponeuroses either of covering or insertion have a similar intermixing. 5th. Wherever the tendons are expanded, they are also confounded with this membrane. 6th. At the two extremities of the ligaments it unites also its fibres to theirs. There are none scarcely except the albuginea, the perichondrium of the larynx, the membranes of the spleen and the kidney, that form an exception to this general rule.

The fibrous system should be considered then in a general manner, that is to say, as extending itself everywhere, belonging at the same time to many organic apparatus, distinct in each by its form, but continuous in the greatest number, having everywhere communications. This manner of describing it will appear still more natural, if we consider that the periosteum, the general boundary of the different portions of this system, is itself everywhere continuous, and at the place where the articulations divide it, the fibrous capsules and the ligaments serve, as we have said, to reunite it.

We understand from this use of the periosteum in relation to the fibrous system, what the advantage is of its situation upon the bones which offer it a solid support, and give the same also to the organs of which it is the boundary.

ARTICLE SECOND.

ORGANIZATION OF THE FIBROUS SYSTEM.

In the midst of the varieties of form that we have just examined, the general organization of the fibrous organs is always nearly the same. I shall now consider this organization; I shall treat elsewhere of the varieties it experiences in each part. It arises from the union of a peculiar texture and of the vascular, cellular systems, &c.

I. _Of the Texture peculiar to the Organization of the Fibrous System._

Every fibrous organ has for a base a fibre of a peculiar nature; hard, but slightly elastic, insensible, scarcely at all contractile, sometimes in juxta-position and parallel to each other, as in the tendons and the ligaments, sometimes crossed in various directions, as in the membranes, the capsules, the fibrous sheaths, &c. but everywhere the same, everywhere of a white or greyish colour, and of a remarkable resistance.

This resistance of the fibrous texture enables all the organs that it composes to support the greatest efforts. Thus these organs are all destined to uses which require this faculty in them. The ligaments forcibly retain the articular surfaces in their proper relation. The aponeuroses confine the muscles and oppose their displacement. The tendons constantly exposed to the contraction of these organs, are at every instant placed between the strong power that they represent and the more or less considerable resistance situated at the extremity of the muscles, &c. Such is this resistance, that it is often greater than that of the bones themselves. We know that by muscular efforts alone, the patella, the olecranon process and the os calcis are sometimes broken; now this could not happen, if the extensor tendons, which corresponded to these different bones, were of a texture that could be more easily torn.

It is to this resistance that must be attributed the following phenomena: 1st. We experience the greatest difficulties in making luxations in the dead body, principally in the articulations called enarthrodial. 2d. In the living subject the external efforts are rarely sufficient to produce them; it is necessary that the powerful action of the muscles should be added. 3d. The punishment formerly employed, of drawing the limbs of criminals by attaching horses to them, was much more terrible, because the resistance of the ligaments made it continue longer; almost always the horses were unable to produce the separation of the extremities; it was necessary that a cutting instrument should assist their efforts. 4th. Weights suspended to a tendon do not break it unless they are enormous; thus the best strings to be employed in the arts would be these textures of the fibrous organs, if drying did not take from these organs their softness and flexibility, if moisture did not alter them, &c. 5th. We cannot without great efforts tear an aponeurosis, especially those of any thickness, as the fascia lata, the albuginea, the dura-mater, &c.

Yet this resistance is sometimes overcome in the living body, and we sometimes see the rupture of the tendons of the solæus, of the small plantaris, of the extensors of the thigh, &c. How does it happen, that the softer texture of the muscle never yields, whilst that of the tendon much more compact is broken? It is because in these cases the fleshy fibres are always in contraction; consequently far from being stretched, as the tendinous fibres are which are then found, if we may so say, passive, their different portions make an effort to approximate each other; and they do in fact approximate; this gives to the muscle a density and hardness equal, and in some cases even much greater, than those of their tendon, as we can ascertain by applying the hand upon a muscle in contraction. A proof that this kind of ruptures is owing to the cause I have mentioned, is this, that if in a dead body we suspend a weight to a muscle detached from the bone at one of its extremities, it will be the fleshy and not the tendinous portion that will break.

The fibrous texture has been considered by some anatomists, as being of a nature approaching that of the muscular texture, and even as being sometimes the continuation of it. Thus they have said that the tendon was formed only by an approximation of the fleshy fibres, which, without changing their nature, only lose their redness. Thus the aponeuroses of covering have been described as an effect of the pressure of the surrounding bodies upon the most external fleshy fibres. In order to see how little foundation there is for this opinion, it is sufficient to observe, 1st, that the dura-mater, the sclerotica, the periosteum, the ligaments, are evidently of the same nature as the tendons and the aponeuroses, and that yet they differ wholly from the muscular texture; 2d, that the chemical composition, the vital properties, the apparent texture, are entirely different in the tendinous and muscular fibre; 3d, that there is no relation between their functions. There is certainly less analogy between the muscle and the tendon which receives its insertion, than between that and the bone which furnishes an attachment to it, and whose cartilaginous portion approximates it in its nature. A muscle and its tendon form an organic apparatus and not a simple organ.

What is the nature of the fibrous texture? We know not, because we do not know any of its properties that are characteristic; it has only the negative ones of those of the muscular texture which is distinguished by contractility, and of those of the nervous texture which is characterized by sensibility. We always see it in a passive state; it obeys the action that is imparted to it, and has scarcely any of its own.

It establishes a great difference between the organs in which it exists and the skin, the cellular texture, the cartilages, the serous membranes, &c.; thus it was wrong to refer all these parts to one and the same class designated by the name of the white organs, a vague term that is only founded upon external appearances, upon the approximation of analyses yet incomplete, and not upon the texture, the vital properties, the life and the functions of the organs. Fourcroy foresaw that this extremely general division would be abandoned after further experiments.

However this may be, the following are the results which the fibrous texture gives when subjected to maceration, ebullition, drying, the action of the acids, &c.

Exposed to maceration in a moderate temperature, the fibrous texture remains a long time without undergoing any alteration; it preserves its size, form and density; gradually this last diminishes; the texture softens; but it does not dilate and swell up; its fibres can then be separated from each other; we see distinctly between them the cellular texture that unites them. Finally at the end of a very long time, they become changed into a soft, whitish pulp, which appears to be homogeneous. All the fibrous organs do not soften equally quick in this way. The tendons are the first to yield to maceration. Then come the aponeuroses; among these, those which are formed by the expansion of a tendon, soften quicker than those destined to cover the limbs, as the fascia lata, for example. The fibrous membranes, the capsules and the sheaths of the same nature are more resisting. Finally the ligaments yield the slowest to the action of water which tends to soften them; yet when they come originally from a tendon, as the inferior ligament of the patella, they are more easily macerated. I have made comparatively, experiments upon all these organs; they give the results that I have stated.

Every fibrous organ plunged into boiling water, or exposed to great heat, crisps and contracts like most of the other animal textures; it diminishes in size, hence it is more solid; it becomes elastic which it is not in the natural state, and afterwards it ceases to be so when it becomes softer before passing into the gelatinous state. By placing all the parts of this system at the same time in water which is made gradually to boil, we see that this softening comes upon all at the same degree, and with nearly the same force. This force, which tends then to make the fibres of this system contract is very considerable; it is sufficient to break at the place of their attachments, those of the periosteum which it raises, by this mechanism, from all the bones that have been boiled for a length of time; to detach the interosseous ligaments, the obturator membrane, &c. when we plunge them into boiling water, with the bones to which they adhere; to contract so strongly the articular surfaces against each other, that they cannot be moved, when, surrounded with their ligaments, they have been exposed to the concentrated action of caloric.

The fibrous texture gradually softens in water, becomes yellowish, semi-transparent and finally melts in part. By boiling together all the parts of the fibrous system, I have observed that the tendons soften first, then the aponeuroses, then the membranes, fibrous capsules and sheaths, and finally the ligaments, which are, as in maceration, those that yield last. Many have already made this remark, to which I add that all do not yield equally. Those placed between the layers of the vertebræ are the most tenacious; they do not take that yellow colour, that semi-transparency, common to all the fibrous system when boiled; they remain white and tough; they appear to contain much less gelatine, and to be entirely different in their nature.

Exposed to the action of the air, the fibrous system loses its whiteness by the evaporation of the fluids it contains; it acquires the horny hardening, becomes yellow, in part transparent and breaks with facility. Some days after having been dried, if replunged into water, it becomes nearly as white and soft as it was before; so that we can truly say, that its white colour is owing to water alone; this phenomenon takes place especially in the tendons. I have observed also in these last another remarkable phenomenon; it is that when they have macerated for some time, and are afterwards dried, they do not become yellow in drying, but remain of a very decided white. Without doubt the whole fibrous system would do the same.

The action of sulphuric and nitric acids quickly softens the fibrous texture, and reduces it to a kind of pulp, blackish in one and yellowish in the other; at the instant we plunge this texture into the acid, it crisps and contracts as in boiling water.

The fibrous texture resists in general putrefaction less than the cartilaginous; but it yields to it more slowly than the medullary, the cutaneous, the mucous, &c. In the midst of these putrid and disorganized textures in the subjects in our dissecting rooms, we find this still untouched; it finally becomes changed also. Water in which it has been macerated gives an odour less offensive than that which has been used for the maceration of most of the other systems.

More digestible than the cartilages and the fibro-cartilages, the fibrous texture is less so than most of the others. The experiments of Spallanzani and Gosse prove this. It appears that it yields to the action of the digestive juices in the same order as to maceration, ebullition, &c.; that is, 1st, the tendons; 2d, the aponeuroses; 3d, the different fibrous membranes; 4th, the ligaments, which are the most indigestible. I would observe however that when boiling has once softened the fibrous texture, it is all digested nearly alike. Thus the cartilages are as easy, and even more so, of digestion, than the tendons, when they have become gelatinous, as Spallanzani proved upon himself, though when raw they are much more indigestible.

II. _Of the Common Parts which enter into the Organization of the Fibrous System._

The cellular texture exists in all the fibrous organs; but it is more or less abundant according as the fibres are more or less distant. In certain ligaments, it forms for the fibrous fasciæ, sheaths analogous to those of the muscles; in others, in the tendons, the aponeuroses, &c. we hardly perceive it; but everywhere it becomes very evident by maceration, by morbid affections, as, for example, by the fungi of the dura-mater, by the carcinoma of the testicle, which has seized the albuginea, by certain swellings of the periosteum, &c. In all these cases the fibrous texture relaxed, softened, preternatural, and of a spongy nature permits its fibres to separate and the cellular organ to appear. The development of fleshy granulations, the soft nature which these granulations have in certain wounds in which the fibrous organ is concerned, prove also the existence of the cellular organ there, which is in general in small quantity; this does not contribute a little to produce the resistance and the force of the organs that belong to it. Does this cellular texture contain fat? At first view we can hardly observe it, since we can scarcely distinguish this texture. Yet I have many times observed that by submitting to desiccation portions of aponeuroses, periosteum, dura-mater, &c. entirely stripped of every foreign part, when all these fluids had evaporated, and the organ had the appearance of parchment, a fatty exudation remaining on many places on its surface.

The existence of vessels varies in the fibrous system; much developed in some organs, as in the dura-mater, the periosteum, &c. they are less so in others, as the aponeuroses, and not at all in some, as the tendons. I would observe in general that it is in those in which they are the most evident, that inflammations and the different kinds of tumours are the most frequently observed. The affections of the dura-mater, the periosteum, &c. compared with those of the tendons, are a remarkable proof of this.

I do not know that absorbent vessels have been traced in the fibrous system.

The nerves appear to be equally foreign to it, notwithstanding what has been written on those of the periosteum, the dura-mater, &c. &c.

ARTICLE THIRD.

PROPERTIES OF THE FIBROUS SYSTEM.

I. _Physical Properties._

The fibrous system has but a slight degree of elasticity in the natural state; but when its different organs are taken from the body and dried, they acquire it very considerably; thus the tendons, the aponeurotic expansions, &c. which in a fresh state would be incapable of any vibration, are found to resound in instruments when they are very dry.

II. _Properties of Texture._

The properties of texture are evident in the fibrous system, but they are less so than in many others.

Extensibility is seen in the dura-mater, in hydrocephalus, in the periosteum; in the different enlargements of which the bones are susceptible; in the aponeuroses, in the swelling of the extremities, and the distension of the abdominal parietes, which, as we know, are aponeurotic as well as fleshy; in the fibrous capsules, in articular dropsies; in the tunica sclerotica and albuginea in the swelling of their respective organs.