174 NAVICULARTHIIITIS. 



hesive action — which, be it noted, may ensue without any previous 

 ulceration — to take place around the circumferent borders of the 

 bursa, rather than in the middle or articulatory parts. 



An appearance I have observed adhesion lo take on in cases of 

 not very old date or chronic character, is, a membranous sort of 

 morbid production spreading from the border of attachment of the 

 tendon upon the circumferent surface of the bone : the new forma- 

 tion being of a pink colour, and apparently organised, looking like 

 converted albuminous effusion. Mr. Mogford, of Guernsey, who 

 happened to be with me while I was examining into a case of this 

 description, informed me he had frequently observed a similar con- 

 dition of the joint. 



Brauell's observations hereupon are, — " the flexor tendon fre- 

 quently contracts adhesions with the navicular bone, but not 

 throughout its whole extent of contiguous surface, but only at 

 those places bare of synovial membrane, and where separation and 

 rupture of its superficial fibres has happened. At first, these fibres 

 exhibit no more than partial disconnection or roughening ; gradu- 

 ally, the entire surface becomes covered with elevations and de- 

 pressions, and thoroughly uneven. And now very frequently 

 may be perceived upon it red stricB, looking like muscular fibres, 

 and these appear to be the result of exudation. Sometimes, in 

 places, greenish spots are perceptible. The destruction of the ten- 

 don proceeds with the continuance (and aggravation) of the dis- 

 ease; extending from before backward, in spots, until at length 

 the substance of the tendon becomes so reduced that it is actually 

 transparent : nothing of it, on occasions, remaining save slender 

 softened bundles of fibres, separated from one another. The rup- 

 ture of these is the natural consequence of the ulcerative action ; 

 though before that takes place, the tendon is found to have at- 

 tached itself to a fresh place in the superior and posterior part of 

 the navicular bone : the two parts being also united by a solid 

 fibrous layer furnished by the right superior suspensory ligament, 

 which is very much hypertrophied and thickened for the purpose." 



The Terminations of Navicularthritis, then, may be 

 looked for as follow: — 1. In resolution, or return of the navicular 

 joint to its pristine condition — a termination, it is to be feared, not 



