MUSCLES AND FASCIJ3. 315 



with surrounding parts. An accurate knowledge of the points of attachment 

 of the muscles is of great importance in the determination of their action. By 

 a knowledge of the action of the muscles, the surgeon is able to explain the 

 causes of displacement in various forms of fracture, and the causes which pro- 

 duce distortion in various deformities, and consequently, to adopt appropriate 

 treatment in each case. The relations, also, of some of the muscles, especially 

 those in immediate apposition with the larger bloodvessels, and the surface- 

 markings they produce, should be especially remembered, as they form useful 

 guides in the application of a ligature to those vessels. 



Tendons are white, glistening, fibrous cords, varying in length and thickness, 

 sometimes round, sometimes flattened, of considerable strength, and only slightly 

 elastic. They consist almost entirely of white fibrous tissue, the fibrils of which 

 have an undulating course parallel with each other, and are firmly united 

 together. They are very sparingly supplied with bloodvessels, the smaller 

 tendons presenting in their interior not a trace of them. Nerves also are not 

 present in the smaller tendons ; but the larger ones, as the tendo Achillis, 

 receive nerves which accompany the nutrient vessels. The tendons consist 

 principally of a substance which yields gelatine. 



Aponeuroses are fibrous membranes, of a pearly-white color, iridescent, glisten- 

 ing, and similar in structure to the tendons. They are destitute of nerves, and 

 the thicker ones only sparingly supplied with bloodvessels. 



The tendons and aponeuroses are connected, on the one hand, with the mus- 

 cles ; and, on the other hand, with the movable structures, as the bones, carti- 

 lages, ligaments, fibrous membranes (for instance, the sclerotic), and the syno- 

 vial membranes (Subcrureus, Subanconeus). Where the muscular fibres are in 

 a direct line with those of the tendon or aponeurosis, the two are directly con- 

 tinuous, the muscular fibre being distinguishable from that of the tendon only 

 by its striation. But where the muscular fibre joins the tendon or aponeurosis 

 at an oblique angle, the former terminates, according to 'Kolliker, in rounded 

 extremities, which are received into corresponding depressions on the surface 

 of the latter, the connective tissue between the fibres being continuous with 

 that of the tendon. The latter mode of attachment occurs in all the penniform 

 and bipenniform muscles, and in those muscles the tendons of which commence 

 in a membranous form, as the Grastrocnemius and Soleus. 



The Fasciae (fascia, a bandage) are fibro-areolar or aponeurotic laminae, of 

 variable thickness and strength, found in all regions of the body, investing the 

 softer and more delicate organs. The fasciae have been subdivided, from the 

 structure which they present, into two groups, fibro-areolar or superficial fasciae, 

 and aponeurotic or deep fascia?. 



The fibro-areolar fascia is found immediately beneath the integument over 

 almost the entire surface of the body, and is generally known as the superficial 

 fascia. It connects the skin with the deep or aponeurotic fascia, and consists 

 of fibro-areolar tissue, containing in its meshes pellicles of fat in varying 

 quantity. In the eyelids and scrotum, where adipose tissue is rarely deposited, 

 this tissue is very liable to serous infiltration. The superficial fascia varies in 

 thickness in different parts of the body: in the groin it is so thick as to be 

 capable of being subdivided into several laminae, but in the palm of the hand 

 it is of extreme thinness, and intimately adherent to the integument. The 

 superficial fascia is capable of separation into two or more layers, between 

 which are found the superficial vessels and nerves, and superficial lymphatic 

 glands ; as the superficial epigastric vessels in the abdominal region, the radial 

 and ulnar veins in the forearm, the saphenous veins in the leg and thigh ; cer- 

 tain cutaneous muscles are also situated in the superficial fascia, as the Platysma 

 Myoides in the neck, and the Orbicularis Palpebrarum around the eyelids. 

 This fascia is most distinct at the lower part of the abdomen, the scrotum, peri- 

 naeum, and extremities; is very thin in those regions where muscular fibres are 

 inserted into the integument, as on the side of the neck, the face, and around 



