Un système de chirurgie : théorique et pratique . ont rencontré de tels nodules barbearinglâches pedunculated de franges, le patient avait avancé des difformans d'arthrite de plusieurs articulations de ses articulations, Alors que la maladie ne commençait que dans celle dans laquelle le corps lâche a été trouvé.^ Que des affleurements osseux cartilagineux similaires peuvent sommager la frontière de l'articulation du cartilage ou du périosteum incrustés, sous l'estimulus, et d'ici se détacher par mouvement, est également cru, mais c'est probablement exceptionnel. L'oiigin traumatique est aussi tAvofold. Soit (a) une partie du cartilage incrustant ^

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A system of surgery : theoretical and practical . have met with such fringes bearingloose pedunculated nodules, the patient had advanced arthritis deformans of several ofher joints, while the disease was only just commencing in that in which the loosebody was found.^ That similar cartilaginous bony outgrowths may spring up atthe border of the joint from the encrusting cartilage or periosteum, under the samestimulus, and from here become detached by movement, is also believed, but this isprobably exceptional. The traumatic oiigin is also tAvofold. Either (a) a part of the encrusting cartilage ^oi- of a meniscus ^ is actually torn away by violence, and becomes partly or entirely 1 Volkmann, Pitha-Billroths Handhuch der Chirurcjie, Einband 5, i. p. 674.- Trains. Path. Soc. vol. xxx. p. 8-53. 3 Quoted by Barwell, op. cit. p. 268. ^ Cornil and Eanvier, Histolog. Path. 1881, p. 447. ^ Ibid. p. 470. « Author, Trans. Path. Soc. vol. xxx. p. 353. ^ Hase, Deutsch. Klinik. 1867, No. 48.* Broadhurst, Trans. Path. Soc. vol. xviii. p. 214. A A 2. 356 DISEASES OF THE JOINTS. free to move about the joint or (6) a certain area of the encrusting cartilage, havingbeen injured by concussion, a slow process of quiet necrosis, as it was called l^ySir J. Paget, takes place around the part struck, and without any suppuration thepiece injured is shred off into the joint. This view, first put forward by Mr. Teale, ^was supported by the observations of Klein ^ and Paget ^ in cases which they have re-corded (loc. cit.) In two of these, where death followed operation, the loose bodies, con-sisting of a layer of cartilage with a plate of bone on one aspect, were found to fitaccurately into a corresponding depression on a condyle of the femur, and there was adistinct history of injury in all. Mr. Barwell, too, * records cases of traumatic origin, probably in this sense also. Finally, a case is recorded ^ in which the point of a needle was found as a nucleusof one of these bodies after its removal b

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