It is stated very generally that the opinion of Bichat is entirely unfounded ; that inflam mation of the vagina is followed by complete occlusion, without destruction or transforma tion of the mucous membrane, and that similar effects may occur in the Fallopian tubes, the uterus, and other mucous canals. That these are produced is perfectly true, but never until the disorganization to which I have alluded has occurred.
It is maintained triumphantly as a cod firination of the opinion that no transformation occurs, that when these adhesions are sepa rated, we have the healthy mucous membrane performing its functions as before. This, how ever, is not the case ; the membrane is essen tially different, and it is not without difficulty that we can overcome its tendency to enter into adhesion again. That a membrane is pro duced, which performs functions analogous to the primitive membrane, is true. If we ex amine a fistulous canal which has existed for a certain time, we find it invested by a mem brane similar in appearance, and performing an analogous function to the primitive mucous membrane,—so rapidly does nature under cer tain circumstances adapt an organ to the per formance of the function to which it is des tined.
As it is therefore upon the organization of this pseudo-membrane that the species of union of which I am treating is dependent, some re mark upon that subject becomes necessary. It has been maintained by Albers, Siiemmering, andLarrey, that these new formations upon mu cous membranes may become organized. The former of these gentlemen believes that the false membrane of croup is commonly organ ized. Soemmering, it is said, possessed pre parations which demonstrated the fact. Cail lean* supports this opinion, as well as Vii lermet and Guersent.$ I have never seen this membrane present the slightest vestige of organization, nor have I ever found any one, with the exceptions I have named, who has, although, to my knowledge, they have been sought for during many years, by a number of the most competent observers of the present day. And as I believe the investigations of morbid phenomena are more accurately made at present than at any former period, I adhere to the opinion that organization of these branes upon mucous surfaces never occurs; and that union by " the first intention " can never occur in those canals which are invested by mucous membrane. But when the com position of the mucous membrane becomes destroyed or disorganized by inflammation, and a granular surface is presented, adhesion may be and is frequently produced.
The epidermis with which the skin is fur nished forms an inorganic stratum which is opposed to all adhesion ; but remove this epidermis, render the surface bleeding, or sup purating, and adhesion may be produced with the greatest facility. It is against this ten dency we have constantly to struggle for the purpose of preventing the adhesion of fingers to each other, to the palm of the hand, and so on,—so common a consequence of burns. Adhesion may in this tissue occur, therefore, by the.development of the fibrino-albuminous medium, or by that of granulations. The synovial membrane of joints may become adherent, constituting a species of ankylosis, which is termed " false." In these cases the secretion of synovia diminishes and ultimately ceases, the contiguous surfaces lose their polish, become rugous, and contract adhesions. (See JOINTS.) In osseous tissues, adhesion may be effected either through the agency of the albumino - fibrinous exhalation already de scribed, or that of granulations. (See BONE.) In cartilaginous tissues the mechanism of ad hesion is different; and in speaking of the process in these tissues, it is necessary to di vide the tissue into those which are invested by a more or less dense fibrous perichondrium, and those which are without it.. To the first appertain the cartilages of the ribs, of the larynx, and all those which Bichat termed fibro cartilages. The second class comprehend the diarthrodial. It is in fact, I believe, upon the presence or absence of the perichondrium, that are dependent the principal differences which are presented in the pathological condition of these organs. The non-diarthrodial as well as the fibro-cartilages, when they are ruptured or divided, are not united by a cartilaginous substance.
In the wounds of cartilages, with loss of substance, there is formed a kind of cellulous matter, which is a secretion from the-perichon drium ; in fact no phenomena of reproduction are observed where this membrane does not exist ; thus it is never observed in diarthrodial cartilages. We may cut and mutilate these latter, and after many days we shall find the wound almost as it was on the first day. When the cartilages of the ribs are ruptured, their union is often effected by an osseous ring which surrounds the two fragments. See the articles ARTERY, ENCEPHALON, NERVE, FI BROUS TISSUE, MUSCLE, VEIN, for the pheno mena of adhesion in these structures.