General Anatomy, Applied to Physiology and Medicine, Vol. 3 (of 3)

by Xavier Bichat

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.