Chapter VII: Part 7

Do not these various resemblances, which with some slight differences of composition only, so evidently connect the synovia with the fluid of the serous membranes, lead us to this very simple consequence, viz. that these two fluids being analogous in all other respects must be so also as to the manner in which they are separated from the mass of blood? Now it is a point in physiology at the present day generally acknowledged, that the fluid of the serous membranes is brought to them by exhalation; then we are evidently lead by induction to this which answers the question proposed above; The synovia is transmitted by exhalation to the articular surfaces.

This rigorous and accurate conclusion drawn from obvious and uniform facts will become, I think, a demonstrated truth, when to the analogies already established we shall add that of the membranous organ, the essential seat of the exhalation of the synovia.

II. _Remarks upon the Synovia._

Thus separated from the mass of blood, the synovia has the appearance of a white, viscid and transparent fluid. It ropes, like some syrups, when it flows from the articulations. This unctuous property renders it peculiarly fit to lubricate the articular surfaces which rub together, and to protect them from violent shocks.

Its quantity varies; there are articulations which contain much of it; that of the ankle has always appeared to me to have the most of it. Then come the ilio-femoral, the scapulo-humeral, the humero-cubital, &c. There are others in which there is scarcely any; such are the sterno-clavicular, the sterno-costals, the costo-vertebrals, &c. It is not the smallness of the synovial surfaces that occasions in these articulations the constant dryness that is observed in them; for the synovial sacs of the larynx, which are much smaller, are much more moist.

Besides, the synovia does not vary in quantity in each articulation, like the serum in the serous membranes. Those who have opened peritoneums, pleuras, pericardiums, &c. must have seen that hardly two are similar; sometimes there is only a mere dew, at others there is a real collection of fluid. Here on the contrary there is always nearly the same quantity; which is owing to this, that the synovial surface does not feel as easily as the serous surfaces, the sympathetic influences of the other organs when diseased.

The synovia is not subject to the different alterations which the serous fluids exhibit. I have never seen upon the articular surfaces what are called false membranes from inflammation. The preternatural collections of synovia never contain those white flakes, so common in the serous collections. I do not know of an example of milky serum effused in an articulation. One of the most frequent alterations of the synovia is that, I think, in which it takes the consistence of a jelly and is of a reddish colour, analogous, if I may be allowed the comparison, to currant jelly. Now this alteration is wholly foreign to the serous fluids.

These essential differences which the synovia and the serum exhibit in their alterations, evidently suppose a diversity of nature in the principles which compose them in the natural state. The viscidity of one and the greater fluidity of the other, also declare it, as Fourcroy has observed. This diversity of nature appears to depend especially upon a peculiar substance which enters into the composition of the synovia, which few animal fluids possess, which Marguerron who has observed it designates by the name of albumen of a peculiar nature, and which should be the object of new researches.

I shall not give here the details of the analysis of the synovia; they belong to animal chemistry.

III. _Of the Synovial Membranes._

We have seen all the great cavities lined by the serous membranes, which form by their folds species of sacs without an opening, and which embrace both the organs and the parietes of these cavities. There exists in all the moveable articulations membranes precisely analogous, the uses of which are the same, the nature of which is not different and which I call synovial, because their parietes constantly exhale and absorb synovia.

_Forms._

Every synovial membrane then, should be considered as a sac without an opening, spread upon the organs of articulation, upon the diarthrodial cartilages, upon the internal face of the lateral and capsular ligaments, upon the whole of the inter-articular ligaments when they exist, upon the prominent fatty bunches in some articular cavities, &c. It is from it that these different organs borrow the smooth, polished and shining appearance which characterizes them in these cavities, and which they have not elsewhere. Just as by dissecting carefully the gastric organs, the peritoneum can be removed, its sac remaining whole, so we can conceive of the possibility of separating this membrane, notwithstanding the intimate adhesions it forms in some places. All the parts that it embraces are out of the articular cavity, though projecting into this cavity, as the lungs are found on the exterior of the sac formed by the pleura, the liver on the exterior of the peritoneal sac, &c. &c.

The synovial membrane is found in all the moveable articulations, the greatest number of which has only it and the lateral ligaments. What is commonly called the fibrous capsule is only met with around some of the articular surfaces. The connexions of the humerus, the femur, and one or two other bones, the extremities of which are joined by enarthrosis, present the only examples of it. There are seen in these articulations two very distinct coverings. One which is fibrous is external, and is found arranged in the form of a sac open above and below, embracing by its two great openings the surfaces of the two bones, and being intermixed around them with the periosteum, the fibres of both interlace with each other. The other cellular, which is the synovial membrane, lines the first on the interior, separates afterwards from it when it arrives towards the two diarthrodial cartilages, and is reflected upon them, instead of being united to the periosteum. Boyer has pointed out this arrangement in regard to the femur.

In all the ginglymoid articulations, as in those of the elbow, the knee, the phalanges, the hand, the foot, &c. &c. the fibrous capsule is wholly wanting. The fibres, instead of extending and interlacing in the form of a membrane, are collected into fasciculi more or less thick, which form the lateral ligaments. There is only found in them the internal layer of the enarthrodial articulations, that is to say the synovial membrane, which does not contract here any adhesion with the periosteum, but is reflected upon the cartilages. By taking it at the place of this reflection, it can be detached far enough to prove that it has an external organization wholly different from that which the idea of a capsular ligament at first presents to the mind. This arrangement is very easily perceived by the least dissection, at the knee behind the tendon of the cruræus and the inferior ligament of the patella, at the elbow under the tendon of the triceps, at the phalanges under that of the extensor, &c. All the arthrodial articulations have also an analogous organization, as will be seen in the Descriptive Anatomy; so that it is ascertained that the fibrous capsules exist but in a very small number of articulations, that almost all have only synovial sacs which are spread out and reflected upon the osseous surfaces, without being attached around them, as all authors have said.

I have proved this remarkable difference of the articulations by many dissections. Some anatomists were in the way to discover it, when they observed that the different capsules appeared to be wholly formed of cellular texture. It is in fact the texture of the synovial membrane, which differs essentially in this from the fibrous capsules. The mode of capsule for all articulations may be preserved, if it is wished, but different ideas must then necessarily be attributed to it. Compare, for example, the fibrous capsule of the femur with the synovial capsule of the knee; you will find on the one hand, 1st, a cylindrical sac with two great openings for the osseous extremities, and with many small ones for the vessels; 2d, a fibrous interlacing, similar to that of the tendons, the aponeuroses, &c.; 3d, a mode of sensibility analogous to that of these organs; 4th, the use of retaining strongly in place the articulated bones, which have only this bond to strengthen their union. On the other hand you will observe, 1st, a sac without an opening; 2d, a cellular structure, the same as that of the serous membranes; 3d, a sensibility of the same nature as theirs; 4th, the simple function of containing the synovia and separating it, the bones being tied by strong ligaments. Besides, the different reagents have upon the fibrous capsules an influence wholly different from that which they exert upon the synovial. Ebullition yellows them, renders them semi-transparent, softens them like tendons and gradually melts them like gelatine. The synovial ones boiled remain whitish, and furnish but little of this substance. I would observe that the yellowish tinge and semi-transparency of the boiled fibrous capsules are a certain means of distinguishing the articulations in which they exist and those which are destitute of them.

The existence of the synovial capsule in the greatest number of articulations in which it is found alone, is placed beyond a doubt by the slightest inspection. In those in which it is united to a fibrous capsule, it is very clearly distinguished in several places. Thus in the thigh, it is found upon the interarticular ligament, upon the fatty bunch in the cotyloid cavity, and upon the neck of the bone at the places where it leaves the fibrous capsule, to be reflected upon the cartilages, &c.; but its adhesion to these cartilages and to the internal face of the capsule, may excite some doubts as to its arrangement in the form of a sac everywhere closed, which we have attributed to it; it is then essential to offer some considerations that may dissipate these doubts.

1st. However strong the adhesions of the synovial membrane may be, they can be destroyed without a solution of continuity, by a slow, careful dissection begun at the place where the membrane is reflected from the cartilage upon the capsule. It can be taken away in parts after long continued maceration. 2d. In consequence of certain inflammations, this membrane acquires a thickness and opacity which enable us to distinguish it from all the neighbouring organs, from those even to which it adheres the most. 3d. The synovial bags are all as adherent as the articular synovial one, to the cartilages of their sheath and to this sheath itself; yet every one acknowledges their distinct existence. 4th. There are articulations with a fibrous capsule, in which the fibres are separated so as to leave a space between them through which the synovia would escape, if the synovial membrane did not line them. When air is forced into the articulation, this membrane rises up in these spaces and exhibits a texture wholly different from that of the capsule. Bertin observed this, but thought that these pellicles were insulated, and did not see that they depended upon the continuity of the membrane which is extended over the whole articulation. 5th. We have observed in the article upon the serous system, that the smooth and polished appearance which the surface of the organs and the cavities exhibit, is always given to them by these membranes, and that they never derive it from their peculiar structure; now we shall see that the synovial membrane has almost the same texture as the serous; then it appears that in the places in which the articular organs exhibit this character, it is from it that they receive it, though it cannot be distinguished as well upon these organs, as where it is free. Besides, the articulations that are evidently destitute of this membrane, have not this smooth and polished appearance. Such are the surfaces of the symphysis pubis, and of the sacro-iliac symphysis which are found, though contiguous, unequal, rough, &c. We have also proved that this organic form is never owing to compression.

From these different considerations we may be easily convinced, I think, that notwithstanding the adhesion of the synovial membrane at different points, it should be considered in a manner precisely analogous to that of the serous membranes, that is to say as a real sac without an opening, everywhere contiguous and spread upon all the organs of the articulation. Besides, do not the fibroserous membranes exhibit similar adhesions, though the separate existence of the two layers which compose them is generally admitted?

From the idea we have formed of the synovial membrane, it is easy to conceive how certain organs pass through the articulation, without the escape of the synovia by the opening which receives or by that which transmits them. The synovial membrane then reflected around these organs, forms for them a sheath which separates them from the fluid and keeps them distinct from the articulation. Thus the tendon of the biceps is no more contained in the articulation of the arm with the scapula, than the umbilical vein, the urachus, &c. are in the peritoneal cavity. With the least care it may be separated from the portion of membrane which forms its sheath.

The preceding considerations lead us also to find a perfect identity in the synovial capsules of the tendons and the articular synovial ones. In the preceding example, these two kinds of membranes are evidently continuous; for the capsule of the groove of the biceps is of the same nature as that of the tendons which have a separate one from it, as the flexors, for example.

_Organization._

We have just seen, that the synovial membrane resembles very much in its external conformation the class of serous membranes, it does not less so in its internal organization. This organization is cellular, as is proved by dissection, inflation and especially maceration. The sac which the ganglions form is evidently only a production of the cellular organ; now it is known that this sac exhales and contains a fluid similar to the synovia. Wherever the synovial membrane is free, it is attached externally to this organ and is confounded with it in so direct a manner, that by raising successively its different layers they are seen to be gradually condensed and finally united together to form it. So that in the serous membranes no fibre is visible. It becomes transparent when it is separated accurately on both sides, which is easily done at the knee to a great extent.

I shall not go back to the various proofs which establish the cellular structure of the serous system; almost all these proofs are applicable to the synovial system, which appears to be but a net-work of absorbents and exhalants. Hence it is easy to understand what the red and fatty bunches are that are found around the articulations. They perform in regard to this membrane the functions of the abundant cellular texture which envelops the peritoneum, the pleura, &c. &c. It is there that the blood vessels divide ad infinitum before arriving at the membrane where their ramifications, successively decreasing, finally terminate in the exhalants.

If a remarkable redness sometimes distinguishes these bunches from the cellular texture, it is because the vessels are more concentrated and nearer together in them. For example, in the articulation of the hip, the synovial membrane of which, almost everywhere adherent, only corresponds in the fissure of the cotyloid cavity with the cellular texture, nature has placed there almost all the arterial ramifications that furnish the synovia; hence the reddish tinge of the cellular bunch that is found there. On the contrary, at the knee where much cellular texture surrounds the whole external face of the synovial sac, the vessels more scattered leave to this texture the same colour as that of the external face of the serous membranes, &c. This redness of some pretended synovial glands, the only character that distinguishes them, is then as it were merely accidental; it no more indicates their glandular nature, than it proves it in the pia-mater, in which it is owing to the same cause.

Though the synovial membrane is very analogous to the serous surfaces, it must however exhibit differences of texture, since the fluid it exhales is a little different. In fact, by examining it at the femoro-tibial articulation, where it can be found in considerable pieces, it is seen to be more dense and compact than the serous membranes. Its texture has not the suppleness of theirs; when dried, it is much more brittle; it remains stiff, whilst the serous texture is moved in all directions without the least effort. It resists maceration longer.

_Properties._

The properties of texture become evident in articular dropsies, in which the synovial membranes are at first much distended, and in which they contract after the puncture, an operation however that is very rare. Yet it appears that these membranes are only susceptible of a slow and gradual extension. We know that suddenly separated in luxations, their parietes tear instead of stretching; they unite again after the reduction.

Among the vital properties, the organic sensibility is the only one of this system in the ordinary state, as I have proved by many experiments on living animals in which these surfaces have been laid bare and irritated by various agents. But the increase of life which inflammation produces by raising this sensibility, transforms it into animal sensibility; this is what is observed, 1st, in the wounds in which these membranes are exposed to the contact of the air; 2d, in the long continued irritation they experience from foreign bodies preternaturally developed in the articulation; 3d, in the various affections of the articular surfaces, &c.

This kind of sensibility of the synovial membranes serves to confirm what I have already established above, viz. that most of the articulations, the ginglymoid especially, are destitute of fibrous capsules. In fact, I have observed that these capsules, as well as the lateral ligaments, have a kind of animal sensibility, which is developed by pulling them; so that if all the neighbouring organs of an articulation, except the synovial membrane and the lateral ligaments, are removed and this articulation afterwards twisted, the animal gives signs of the most acute pain. But afterwards cut the ligaments, and leave only the synovial membrane, the twisting no longer gives pain; then there is no fibrous capsule united to the synovial. This experiment, which is easily repeated upon the fore or hind legs, enables us to recognise everywhere the articulations in which the synovial membrane exists alone, and those in which it is found united to a fibrous capsule. This being of the same texture as the lateral ligaments, produces the same pains when it is pulled, as is proved elsewhere by experiments made upon the articulations clothed with these capsules.

The alternate exhalation and absorption which takes place upon the serous surfaces, prove the insensible contractility in them.

I have already observed that the synovial surfaces perform but a small part in the sympathies, that they feel but very slightly the affections of the other organs. Whilst in the acute affections of the important viscera, the skin, the mucous surfaces, the cellular texture, the nerves, &c. &c. have a greater or less sympathetic derangement, all the synovial membranes remain unaffected; they do not become the seat of irregular pains, nor of a more active or slower exhalation. They resemble in this respect the osseous, cartilaginous, and even fibrous systems. Thus it is not necessary that the physician should seek in the synovial system a frequent seat of the accessory symptoms in diseases, of that class of symptoms which does not belong to the injury of the diseased organ itself, but to its relations with other parts.

In the pains of the articulations, there are certainly cases in which the synovial membrane is diseased, and others in which the fibrous organs alone are affected. The distinction of these cases should be sought.

_Functions._

The synovial membrane adds nothing to the solidity of the articulation. The fibrous capsules and the lateral ligaments alone serve this purpose. The smooth surface which the articular extremities derive from this membrane, favours their motions; it can even in this way assist the muscular action; thus the portions of synovial membrane which are found at the knee behind the cruræus, at the elbow under the triceps, at the phalanges under the flexors, &c. perform in respect to these muscles, the same functions as the tendinous synovial bags. They are to their tendons, what the cellular sac which separates the tendons of the psoas and the iliacus from the crural arch, is to them.

The principal use of the membrane of which we are treating is in relation to the synovia. It exhales by numerous orifices this fluid which remains there for some time, and afterwards re-enters the circulation by absorption. Its parietes are then the seat of exhalation, as the kidneys, for example, are that of the secretion of urine. The reservoir of the exhaled fluid is the sac without opening which it forms, as the bladder is that of the urine that comes from the kidneys. The excretory vessels of this same fluid are the absorbents which carry it into the mass of blood, as the urethra carries the urine from the bladder. There is under these different relations more analogy than there at first seems to be, between secretion and exhalation.

The phenomena of the continuance of the synovia in this membranous reservoir, have relation to the synovia itself or to the articular surfaces. The first consist in a peculiar but unknown alteration which it undergoes between the exhalant and absorbent systems. The second contribute to facilitate the articular motions. The unctuous and slippery coat which the serous surfaces receive from the synovia, is remarkably adapted to this use, as I have observed.

_Natural Development._

In the fœtus and in infancy most of the synovial membranes are much larger in proportion than in the after ages, because the articular surfaces have a greater extent in the cartilaginous than in the osseous state; but they are then extremely delicate. The synovia is not, as the serous fluids are at this age, more unctuous and of greater consistence; it appears even to be less so. Before birth it is in small quantity, no doubt because the motions are trifling.

In old age I have observed that the synovial membrane becomes more dense and compact. It loses in part its white colour and becomes grey; less synovia is exhaled from it. It is not like the serous surfaces, exposed to dropsies. The rigidity it acquires makes motion painful. It never ossifies except preternaturally. The phosphate of lime which gradually invades cartilage, does not take hold of it. I do not know an instance of an old person in whom bone has been found naked in an articulation.

_Preternatural Development._

I have already observed in the article on the fibrous capsules, that when the head of a bone remains displaced in a luxation, it is not a membrane analogous to these capsules that is developed around it; it is a real cyst, smooth on its internal surface, moistened with serum, formed at the expense of the cellular texture, and presenting, with a little more thickness, the true appearance of the synovial membranes; it is a preternatural synovial membrane. The motions imparted to the displaced limb appear to increase the serous exhalation in this new membrane; hence no doubt the great advantage of these motions, in order to re-establish in part the mobility of the bones which remain out of their sockets. I have seen a dancer, the head of whose humerus was lodged in the hollow of the axilla, after a luxation that was not reduced, perform very varied motions with it.

ARTICLE SECOND.

SYNOVIAL SYSTEM OF THE TENDONS.

This system noticed by many authors and described by Fourcroy, Soemmering, &c. is precisely of the same nature as the preceding, from which it differs only by its situation; it is often even confounded with it. Thus the synovial membrane of the tendon of the biceps is continuous with that of the scapulo-humeral articulation; thus those of the gemelli are so with the synovial membrane of the femoro-tibial articulation; it is the same membrane which belongs at the same time to the tendon and to the articulation. A remarkable example of it is seen in the extensors of the leg and the ham, to the tendons of which the same articular synovial membrane of the knee serves for a capsule.

But very few tendinous synovial membranes are found in the trunk; almost all are on the extremities where they serve to assist the slipping of the tendons. They are met with, 1st, where a tendon is reflected at an angle upon a bone, as around those of the great lateral peroneus, the peroneus medius, the obturator internus, the great oblique of the eye, &c.; 2d, where a tendon slips upon an osseous surface without being reflected, as at the extremity of the tendo Achillis, as under that of the great glutæus, and those of the psoas and iliacus united; 3d, where a tendon slips in a fibrous capsule, as in those of all the flexors, &c. Their extent is uniformly in proportion to that of the tendons upon which they are spread.

_Forms; Relations; Synovial Fluid._

The tendinous synovial membranes, are, like the articular ones, sacs without an opening, spread on the one hand on the tendon and on the other upon the neighbouring organs. These sacs are differently shaped according to the arrangement of the tendon, but their general conformation is uniform. We see from this that every tendinous synovial membrane has two faces, one which forms the interior of the sac, which is everywhere free and contiguous to itself, the other which lines the adjacent organs.

The free surface is constantly moistened by a fluid precisely similar to that of the articulations, furnished like it by exhalation, and not as authors have said by red bodies situated in the neighbourhood, bodies of which oftentimes there is no trace visible, and which, when they exist, have nothing glandular in them. This fluid is in general much less abundant than in the articulations, at least in the dead body. But there are varieties in the different synovial bags; those of the tendo Achillis, of the tendons of the psoas and iliacus united, of that of the obturator internus, &c. are always more moist than those of the flexor tendons, &c.

Is it to the absence of synovia that must be attributed the species of crepitation which the tendons sometimes make in their motions? I know not. I would only observe that this crepitation has some analogy with the crackling noise of the joints of the fingers when they are bent quickly, a noise, which does not depend, as might be supposed, on the friction of the osseous surfaces; in fact, when it has been once produced, it cannot be again, though there may be friction again. Besides it is known that this crackling noise arises from the forced elongation of the phalanges, and consequently from the separation of their articular surfaces, as well as from the flexion.

The increase of the fluid of the tendinous synovial membranes forms a species of dropsy which is called ganglion, a tumour which never exists in the synovial membranes of the fingers, no doubt on account of the want of extensibility of the fibrous capsules. It should not be thought however that all these tumours, which are cured by bursting them by strong pressure and thus effusing the fluid into the cellular membrane, have for their base a natural synovial membrane. Most frequently they are preternatural; they are cysts which are formed in the cellular texture. In fact these tumours are often found in the course of the great extensor of the thumb, where there is no synovial membrane. After rheumatic pains I have seen a considerable collection of fluid in the small synovial membrane of the tendo Achillis; it gradually disappeared. I have observed another analogous one in the bag of the psoas of a dead body. The fluid was reddish and of the consistence of currant jelly. The action of nitric acid immediately coagulated it into a white mass, analogous to the white of an egg hardened.

The adhering surface of the tendinous synovial membranes is spread, 1st, on the one hand upon the tendons, with which it is more or less intimately united. It is easily detached from those of the internal obturator, the psoas, &c. It is closely connected with those of the flexors. 2d. On the other hand, it commonly lines the periosteum, which, in this place, is penetrated with gelatine, and forms a fibro-cartilage. Its mode of relation is there analogous to that of the articular synovial membrane with the cartilage of the bone. Sometimes it is reflected upon a fibrous capsule after having lined the tendon; such are those which are in the neighbourhood of the scapulo-humeral articulation. In some cases, after having lined the tendon, they mount up to the fleshy fibres, as on the obturator internus. 3d. By reflecting from the tendon upon the neighbouring organs, they answer in general instead of much cellular texture; but in the grooves of the flexors, it is the fibrous sheaths which they clothe.

In all the great motions, the tendinous synovial membranes, stretched more or less, undergo various locomotions, always less however than those of the serous surfaces.

The very various forms, which the sac without opening of the tendinous synovial membranes exhibits, can be reduced to two general modifications. 1st. Some are rounded sacs, species of bladders; such are those upon the supra-spinatus, the psoas, iliacus, obturator internus, &c. All these membranes are remarkable for this, that they never cover the tendon entirely, but only on one side; that they never form internal folds and that they are never surrounded by fibrous sheaths. 2d. The others, belonging especially to the flexors, and to the different tendons which traverse the sole of the foot, form at first a kind of cylindrical sac which lines the canal half fibrous, half cartilaginous in which the tendon slips; then they are reflected around it, cover it wholly and form for it a true sheath which prevents it from being moistened by the synovia. This kind of tendinous synovial membrane represents then truly two canals, at the superior and inferior extremities of which are found two cul-de-sacs which unite them and complete the sac without an opening. Internal folds are here frequently found going from one canal to the other. All the synovial membranes of the flexors have one of them under the tendon.

_Organization; Properties; Development._

The organization of the tendinous synovial membranes is precisely analogous to that of the articular ones. Principally cellular, the texture of these membranes is without any apparent fibre; its softness is very evident; very few blood vessels are distributed to it, though the contrary has been said; absorbents and exhalants especially predominate in it. These, filled with blood in inflammation, give to the membrane, a reddish tinge, more or less deep. In this state the synovia is not exhaled; sometimes even adhesions are formed, as I have observed in a subject in whom the fibrous sheaths and their tendons of the index and the middle finger seemed to be united. The inflammatory phenomena of the tendinous synovial membranes are especially remarkable in whitlows, a disease, one species of which has evidently its seat in the synovial membrane of the fingers, is analogous to the inflammation of the pleura, the peritoneum, and to that of the articulations. It is more dangerous than the inflammation of the synovial membranes in the form of bladders or bags, because the fibrous sheath which surrounds the inflamed membrane, not being able to stretch and yield to the swelling, like the cellular texture which surrounds the synovial bags, produces real strangulations, which it is often necessary to remove. I do not know whether the synovial texture of the tendons is exposed to the slow and tubercular inflammations, common to the articular serous and synovial systems. Its vital properties and those of texture appear to be precisely the same as those of this last. Like it, it receives with difficulty the sympathetic influence of the other organs; it is unaffected during the derangement of the other systems in acute diseases; it remains sound in their alterations arising from chronic affections. I would observe also that all its affections are almost local. For example, there is not, as in the serous system, species of dropsical diathesis, that is to say of cases in which all the synovial sacs are filled at the same time.

The tendinous synovial membranes, fine and delicate in the fœtus and in infancy, readily yield to the numerous motions which constantly succeed that age. More dense and compact in the adult, they become rigid in old age, exhale less fluid, are dry, and do not contribute a little, by the state in which they are, to the general slowness of the motions which that age brings with it.

There are many synovial membranes the existence of which is variable; such as, for example, that of the great glutæus, in the place of which there is often found only a cellular mass. These membranes are in general very dry when they exist. Synovia can scarcely be discovered in them. They resemble in this respect the articular synovial membranes of the vertebræ, the clavicle, &c.

GLANDULAR SYSTEM.

This system, one of the most important in the animal economy, differs from most others in this, that the texture which is peculiar to it is not precisely the same in all the organs that compose it. The fibres of a muscle of animal life would as well serve for the structure of any other muscle of the same system. The tendinous fibres, the cartilaginous, osseous textures, &c. are everywhere the same. On the contrary, the texture of the liver would not serve to compose the kidney, nor that of this last the salivary glands. The glandular system then has a resemblance in its different parts only by certain general attributes which have many exceptions.

Authors have given the name of glands to organs to which it does not belong; such as the thyroid, the pineal, the lymphatic glands, those especially that are in the neighbourhood of the bronchia, the thymus, the suprarenal, &c. We should call by this name only a body from which flows, by one or many ducts, a fluid which this body separates from the blood which it receives by the vessels that go to it. 1st. On the head, the salivary, the lachrymal, the Meibomian and the ceruminous glands of the ear, and the amygdalæ.; 2d, the mammæ on the thorax; 3d, in the abdomen, the liver, the pancreas and the kidneys; 4th, in the pelvis, the prostate and the testicles; 5th, on the whole trunk and the face, the very numerous collection of mucous glands; these are nearly all that are dependant upon the glandular system; all the other organs which belong to it by this name, are foreign to it in their texture, their properties, their life and their functions. In this point of view, the division of Vicq d’Azyr is inaccurate.

The extremities contain nothing which belong to this system, no doubt because the fluids which it separates almost all serve for the functions of organic life, whilst in the extremities every thing is in relation to animal functions.

ARTICLE FIRST.

SITUATION, FORMS, DIVISION, &C. OF THE GLANDULAR SYSTEM.

The glands have two different positions. Some of them are sub-cutaneous, as the mammæ, the salivary glands, &c.; the others deep seated, as the liver, the kidneys, the pancreas and almost all the mucous ones are removed from the action of external bodies. The greatest number occupy places where there is constantly much motion, as the salivary glands on account of the jaw, the mucous on account of the neighbouring fleshy layer, the liver on account of the diaphragm, &c. It is this which has made it believed that this motion, foreign to their functions, was destined to produce the excretion of their fluids. But, 1st, the glands of the palatine arch, the pancreas, the testicles, the kidneys even, can hardly borrow accessory aid on account of their position. 2d. We know that the sight alone of grateful food makes the saliva flow. 3d. Sialagogues produce the same effect. 4th. When the bladder is paralytic, the mucous juices pour into it as before, oftentimes more copiously. 5th. The semen flows involuntarily. 6th. The excretion of the mucous juices is as easy in the pituitary membrane as any where else, though the fleshy layer, almost everywhere spread under the mucous system, is wholly wanting here. A thousand other analogous facts prove this truth placed beyond a doubt by Bordeu, viz. that the vital action is the essential cause of every excretion.

Accessory aid should not however be entirely rejected. In fact, in salivary fistulas, there is evidently more fluid thrown out during mastication than at any other time. It is evident that in the excretion of urine, the abdominal muscles perform the principal part. When the gall-bladder is emptied, I believe that the neighbouring motions are much assistance to it. In general, whenever the fluids are found in considerable quantities, if the parietes of the organs which contain them are not very strong, like those of the heart, the motions of the neighbouring organs are necessary to overcome the resistance which they offer. On the contrary, in the capillary vessels in which the fluids are in small quantities, the organ that contains them is sufficient, by its reaction, for the motion.

There are single glands like the liver, the pancreas, &c.; and others in pairs, as the kidneys, the salivary, lachrymal glands, &c. These resemble each other in general on both sides; but their resemblance is not to be compared for precision to that of the organs in pairs of animal life. One of the kidneys is lower than the other; their arteries, veins and nerves are not analogous either in length or size; frequently fissures exist in one that are wanting in the other, &c. The same observation is true with respect to the salivary glands.

The glandular forms are not fixed and invariable; they exhibit a thousand different modifications in their size, direction and proportions; they have never the precise and exact conformation of the organs of animal life. This fact can be disputed by no one who has examined a number of dead bodies. The following are the means by which I have made this most evident to myself. We know that the organs vary much in size, in different individuals; now, in these varieties the proportions are always accurately kept in animal life, whilst it is rare that they are so in organic life. Let us take an organ for example in each of the two lives. I have always seen that in a small brain the corpus callosum, the thalami nervorum opticorum, the corpora striata, &c. are in proportion to the whole size of the organ. On the contrary, nothing is more common than to see a large lobe of Spigelius with a small liver, and vice versa a large liver with a small lobe. There is no anatomist who has not had frequent occasion to make this remarkable observation. A kidney is larger sometimes in its superior part, sometimes in its inferior, &c. It is in the whole of the organ that these varieties of size take place in animal life; it is oftentimes in insulated parts only in organic life. The reason of this appears to me to be that the harmony of action is necessary, as I have demonstrated, for the animal functions; so that if one side of the brain is more developed than the other, if one eye, one ear, one pituitary membrane, &c. are more developed than their corresponding organs, the perception, the sight, the hearing, the smell, &c. would be inevitably deranged; whilst the secretion of bile, of urine, &c. takes place equally well, though one part of these glands may be larger or smaller than the other parts.

There is a remark to be made respecting the glands with regard to these varieties of form, it is, that those which are covered by a membrane, as the liver, the kidneys, even the pancreas, are less exposed to them than those which are buried in cellular texture without having around them a membranous covering, as the salivary, the lachrymal, the mucous glands, &c. I have often examined these last in the mouth and in the course of the trachea; I never found them alike in two subjects. We know that the parotid sometimes extends upon the masseter, and sometimes does not, that it descends more or less into the neck, that it is of a greater or less size there, &c.

When one gland of a pair is wanting or becomes diseased, sometimes the other increases considerably in size, as I have seen in the kidneys. This takes place also in the treatment by compression of salivary fistulas, a treatment which does not however always succeed. In other cases, the sound gland increases its action and secretes more fluid, without increasing in size.

The exterior of the glands not covered by membranes is unequal and lobulated; it conforms to the muscles, the vessels, the nerves, and even the bones, as the parotid which is placed under the angle of the jaw. Less cellular texture is in general found around them, than around organs with great motion. That which is in contact with them is more dense and compact than that of the organic interstices. It closely resembles the sub-mucous texture, that exterior to the arteries, the veins, the excretories, &c. but it is not however so resisting. It receives fat with difficulty, and forms a kind of membrane, which, insulating to a certain extent the vitality of the gland, performs in great measure in this respect the functions of the peritoneum around the liver, of the peculiar membrane of the kidneys, the spleen, &c.

ARTICLE SECOND.

ORGANIZATION OF THE GLANDULAR SYSTEM.

I. _Texture peculiar to the Organization of this System._

The glandular texture is distinct from most of the others in this, that the fibrous arrangement is wholly foreign to it. The elements that compose it are not placed at the side of each other, in longitudinal or oblique lines, as in the muscles, the fibrous bodies, the bones, the nerves, &c. They are found agglomerated, united by cellular texture, and adhere but very slightly. Thus whilst the organs with distinct fibres resist much, especially in the direction of their fibres, these are torn with the least effort, and break even with ease. Their rupture is unequal, full of prominences and depressions, a difference which distinguishes them from cartilage, the rupture of which is in general smooth. This rupture is not equally easy in all the glands. The prostate, the amygdalæ, the mucous glands resist much more than the liver or the kidneys, which principally exhibit this phenomenon. The pancreas and salivary glands yield a little without breaking, when they are pulled; but it is not their texture which is the seat of this phenomenon, it is the abundant cellular texture that penetrates them; thus their different lobes are then separated, in proportion as the filaments which are between them become longer.

The glandular texture, which is very commonly called parenchyma, is in general arranged in three different ways. 1st. In the pancreas, the salivary and lachrymal glands, there are distinct lobes, separated by cellular texture, resulting from smaller lobes which are agglomerated together and which are composed of still less lobes, that are called glandular grains; the scalpel traces with ease the first, second, third and even fourth divisions. 2d. In the liver and the kidneys there is found no trace of the first of these divisions, of those into principal and even secondary lobes. The glandular grains all in juxta-position, having between them an equal quantity of cellular texture, a quantity which is very small, as we shall see, present an uniform texture without inequality, which is broken with ease, as I have said, and the rupture of which exhibits species of granulations. 3d. The prostate, the amygdalæ and all the mucous glands have a soft parenchyma, like pulp, without the appearance of principal or secondary lobes, or even glandular grains, not breaking, yielding much more under the finger that compresses it, than that of the other glands. The simple inspection of the glandular system is sufficient to enable any one to perceive the triple difference which I have just pointed out, and which is essential. The testicles and the mammæ have a peculiar texture which cannot be referred to these differences.

Authors have been much occupied with the intimate structure of the glands. Malpighi admitted that there were small bodies in them, which he believed were formed of a peculiar nature. Ruysch determined that they were all vascular. Let us neglect all these idle questions, in which neither inspection nor experiment can guide us. Let us begin to study anatomy where the organs can be subjected to our senses. The exact progress of the sciences in this age is not accommodated to all these hypotheses, which made general anatomy and physiology but a frivolous romance in the last.

There is no doubt that the excretories communicate with the arteries which penetrate the glands. Injections made in these escape with great ease by the first, without there being any trace of extravasation in the gland. The blood flows often naturally by the excretories, and produces sometimes bloody urine, saliva, &c. But do these facts prove that there are only vessels in the glands, that the peculiar parenchyma of which they are the result does not depend on a substance which is peculiar to them? The glands, like all the other organs, as the muscles, the bones, the mucous membranes, &c. have their peculiar texture which especially characterizes them, which belongs only to them, a texture in which the arteries communicate with the veins and the excretories. Let us not push our researches further; if we do, we shall be inevitably entangled in conjectures. Let us confine ourselves to examining what phenomena distinguish this texture from all the others when subjected to the different reagents. It is much to know the characteristic attributes of the glandular system, without seeking to understand its intimate nature, which, like that of all the other systems, is concealed by an impenetrable veil.

The glandular parenchyma dried in the air after having been cut in slices, loses its original colour, takes a deep one, black even in the liver and the kidneys, in which it is owing especially to the blood which penetrates these glands, since if they are dried after having been deprived of it by repeated washing, they remain grey after their drying. No system becomes harder or more brittle than this by this preparation. It diminishes then less in size than most of the others. When immersed in water after being thus dried, it becomes soft, resumes in part its original appearance and its tendency to putrefaction, which takes place immediately if it is left in the open air.

The glandular texture, when exposed to the air so that it does not dry, becomes putrid very quickly, and gives out an odour more fetid than most of the others. More ammonia appears to be disengaged from it. The liver especially produces an insupportable odour when putrid. I do not know any organ, kept in a vessel full of water to macerate, which gives out more disagreeable emanations. The kidney becomes putrid much less quickly; this varies however a little.

When boiled, the glandular texture furnishes in the first moments of ebullition, a great quantity of grey substance, which mixes at first perfectly with the water which it renders turbid and then collects into a copious scum on the top of this fluid. It is this texture, the fleshy, the mucous and the cellular which give the most scum in boiling, as it is the cartilaginous, the tendinous, the aponeurotic, the fibro-cartilaginous, &c. which give the least of it. It should not be believed, moreover, that this first product of stewing is uniform in its nature; it varies in each system in quality as well as quantity. At least I have observed that its appearance is never the same, that it has nothing constant but its frothy state, which also varies much and which is even almost always nothing in the mucous system.

The liquor which results from the boiling is very much changed in colour, and appears to contain many more principles than that made with the white organs. An accurate analysis of the liquor in which each system had been boiled would be an interesting subject of research. I have found that in almost all the appearance, the taste and the colour were different.

The glands exhibit a phenomenon when cooking that especially distinguishes them. They harden at the moment of the first ebullition, and acquire the horny hardness like all the other systems; but whilst most of these soften again from long-continued stewing, so as to become pulpy, the glands uniformly become harder, so that after five or six hours boiling, they are three or four times as hard as they naturally are. I have very often made this experiment, which is also well known in our kitchens, in which when a gland is cooked, care is taken that the stewing should not continue too long. Beef kidney finally becomes soft; those of sheep and of man remain hard for a much longer time. They soften however more than the texture of the liver, which is of all the glands that which exhibits the hardness in the greatest degree.

Another phenomenon which especially distinguishes the ebullition of the glandular system, is that when it is taken out at the moment it has undergone the sudden horny hardening, common to almost all the animal solids plunged into boiling water, it has not like the others acquired elasticity. Draw in an opposite direction a tendon, a serous or mucous membrane or a muscle that have undergone the horny hardening, they stretch and afterwards suddenly contract the instant the extension ceases; on the contrary, a slice of liver that has the horny hardness breaks when it is drawn and never contracts. The texture of the prostate appears to be more capable of then acquiring a little elasticity. The non-fibrous disposition of the glands seems to have much influence upon this phenomenon.

Exposed to the sudden action of a very bright fire as in roasting, the texture of the liver and the other glands crisps and contracts on the exterior. There results from it on the surface a kind of covering impermeable in part to the juices contained in the organ, which in this way becomes cooked in these juices which soften it in the interior. This phenomenon is however common to all the solids. Hence why care is taken to expose what is roasting, whether it be muscular or glandular, at first to the action of a very quick fire; afterwards when the horny hardening of the surface has been produced, it is diminished, and the organ is cooked with a small fire.

The glands macerated in water yield differently to its action. The liver resists it longer than the kidney, which after an experiment of two months made in vessels placed in a cellar has been reduced to a reddish jelly swimming in the water; whilst the first preserved for the same time and a little longer, its form and density, and had only changed its red colour to a blueish brown, whereas the kidney retains its colour in maceration. The salivary glands contain much of this white, unctuous and hard substance, which all the cellular parts when long macerated exhibit. It is not the glandular texture that has changed, but only the fat contained in the cellular texture, which is here very abundant.

The acids act upon the glandular texture nearly the same as upon all the others. They reduce them to a pulp which varies in its colour and the rapidity of its formation, according to the acid employed. The sulphuric is uniformly the most efficacious in producing this pulp which it blackens, whilst the nitric yellows it. All the acids act with much more difficulty upon the glandular texture when stewed, than when raw. My experiments have convinced me that but few systems exhibit this difference in a more remarkable manner.

The glands are much less digestible than many other animal substances, especially when stewed, which produces in them in this respect an effect entirely different from what it does in the cartilages, the tendons, and all the fibrous organs, which by it lose their density, become soft, gelatinous, viscid even and are easier dissolved by the gastric juice. I believe in general that we should digest the glands much easier by eating them raw. Every one knows that the more the liver is cooked, the more indigestible it becomes. This induced me to make a comparative experiment upon this organ cooked and raw; when one portion in the second state was reduced to a pulp in the stomach of a dog, the other portion in the first state swallowed at the same time had just begun to be altered.