266 



FIBROUS TISSUE. 



as the valves are designed by nature to be 

 separated only to a limited extent, an elastic 

 ligamentous structure is placed between them 

 towards their centre, and in this manner all 

 undue separation is prevented without any 

 demand being made on the force of the ad- 

 ductor muscle.* 



MORBID ANATOMY. I. Inflammation. 

 The low degree of organization possessed by 

 this tissue modifies the inflammatory process, 

 which is usually chronic in its nature, and 

 often extremely insidious in its progress ; occa- 

 sionally, however, as in sprains, acute rheu- 

 matism, &c., the fibrous organs are the seat 

 of very active disease. Owing to their great 

 density, but little swelling takes place unless 

 there be chronic and prolonged inflammation ; 

 in which case, as is particularly observed in 

 disease of the joints, a quantity of jelly-like 

 fluid is poured into the interstitial cellular 

 tissue, the proper fibres become massed toge- 

 ther and with the surrounding parts, till in the 

 advanced stage all traces of the original for- 

 mation being lost in the diseased mass, it be- 

 comes reduced to the pulpy consistence of 

 diseased cellular membrane, of which the 

 healthy structure is a modification. 



This deposit and thickening are the most 

 common products of inflammation in liga- 

 mentous parts ; but it occasionally happens 

 that a true abscess is formed, as when pus is 

 thrown out between the dura mater and cra- 

 nium. I have known one case connected with 

 disease of the bone, in which matter was de- 

 posited in the substance of the dura mater, 

 and in which the operation of trephining was 

 ultimately required for the relief of the patient. 



Ulceration is a frequent result of scrophu- 

 lous disease of the joints, causing great ravages 

 in the ligaments and neighbouring parts. 



Mortification of ligament is not a common 

 occurrence, whilst in the acute inflammation 

 of tendon, especially in neglected thecal ab- 

 scess, and of fascia in consequence of large 

 abscess under it, sloughing is not unfrequently 

 witnessed. 



There are of course certain modifications in 

 the effects of inflammation according to the 

 part attacked. Thus, in ligament, there is a 

 great tendency to ulceration ; in tendon to 

 mortification ; in the periosteum to great in- 

 duration ; and, as we see in the formation of a 

 node and of callus, to a transformation into 

 cartilage and even bone. When fascia is the 

 seat of disease, the consolidation arising from 

 effusion often gives rise to a retraction of the 

 affected part; a result which has been observed, 

 for example, in inflammation of the aponeu- 



* Leach, Bullet, des Sciences, 1818. P. 14. 

 [Mr. Hunter fully recognised the value of this 

 elastic tissue, and in his Museum he set apart a 

 series for its illustration under two classes 1st, as 

 an antagonist to muscle, and 2d, in aid of mus- 

 cular action. In the former class he places such 

 examples as that of the oyster alluded to in the 

 text, in the latter the ligamenta nuchae and the 

 elastic fibrous expansion on the abdomen of the 

 elephant and other larger quadrupeds. See the 

 Descriptive and Illustrated Catalogue of the Hun- 

 terian Museum, vol. i. ED.] 



rosis of the fore-arm, and in that affection of 

 the palmar fascia called by Boyer and other 

 writers crispatura tendinum* 



II. Cartilaginous transformation and ossi- 

 fication. Many parts of the fibrous system 



not unfrequently become cartilaginous or even 

 osseous. The cartilaginous transformation is 

 often observed in the ligaments of diseased 

 and anchylosed joints; in the periosteum after 

 fractures and in the formation of nodes; in 

 tendons, especially those which are exposed to 

 great friction in the fibrous covering of the 

 spleen. I have had opportunities of seeing 

 many specimens of cartilaginous deposit taking 

 place between the periosteum and the bone, 

 and evidently arising from the former. The 

 valuable collection of my friend Mr. Liston 

 contains a very fine specimen of a large carti- 

 laginous tumour proceeding from the peri- 

 osteum. 



Ossification, although extremely common, 

 occurs much more frequently in some than in 

 other classes of these organs : thus it is often 

 met with in the dura mater, in which structure, 

 as far as I have observed, the bony excres- 

 cence always proceeds from the inner layer or 

 that towards the arachnoid, and consequently 

 presses against the brain. In one very re- 

 markable specimen in my possession, nearly 

 the whole of the falx, and a large extent of the 

 membrane attached to the vault of the cranium, 

 are completely ossified. In an instance, ob- 

 served I believe by Dr. Barlow (Southwark), 

 the heart was completely encased in bone, 

 owing to the entire ossification of the peri- 

 cardium. The cicatrix of a wounded tendon 

 is often osseous. 



III. Fungus. The dura mater, the peri- 

 osteum, the fascia, &c., are subject to excres- 

 cences having a fungoid appearance, which 

 vary in their nature, often consisting of a 

 chronic, indolent growth, whilst at other times 

 they are evidently scrophulous, and occasion- 

 ally they are malignant. 



In the progress of those cases where the 

 disease is situated near the bones, these organs 

 are implicated, and some doubt has conse- 

 quently arisen concerning the first seat of the 

 disease ; it is, however, proved by examination 

 that in the fungus of the dura mater and other 

 fibrous parts, the bones are only secondarily 

 affected. A good illustration of this fact is 

 afforded by a preparation consisting of an 

 extensive fungus arising from the periosteum 

 covering the tibia, in which it is evident, al- 



* Boyer, Traite des Malad. Chir. torn. v. p. 55. 

 This peculiar affection was so'me years since pointed 

 out by Sir A. Cooper, and has since been more fully 

 described by Baron Dupuytren, (Le9on Orales de 

 Chir. Clin. torn. i. p. 2). The tension and contrac- 

 tion of the palmar fascia, which are usually caused 

 by continued pressure, give rise to aretraction of one 

 or more of the fingers, and may be removed by 

 transversely and freely dividing the aponeurosis 

 opposite to the metacarpo-phalangean joint. I 

 have known one case of similar induration of the 

 fibrous sheath of the corpus cavernosum penis ; 

 and I have learnt from Sir A. Cooper that he has 

 seen several such cases, occurring in persons who 

 had freely indulged in sexual intercourse. Boyer 

 has made a similar observation. 



